Provider Demographics
NPI:1487268934
Name:SCOFERO, STACEY LYNN (LPN)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:SCOFERO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7295 S MARSTELLAR RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85735-2281
Mailing Address - Country:US
Mailing Address - Phone:585-727-1083
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287067164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse