Stacy L Manroe, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA10003512 Issued in WA

Practice address

3897 Cameron Dr NE
Lacey, WA 98516-3888

Phone

(973) 826-8080

Fax

(866) 309-3354

NPI assigned

Apr 15, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1568816528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 US HIGHWAY 46",
            "address_2": "SUITE 400A",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070041592",
            "telephone_number": "973-894-1263",
            "fax_number": "888-972-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3897 CAMERON DR NE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985163888",
            "telephone_number": "973-826-8080",
            "fax_number": "866-309-3354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANROE",
        "first_name": "STACY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-15",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10003512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manassehs Adult Family Home LLC
• Antonette Manigsaca
• Manitou Horizons LLC
• Myhre Manning-Kniestedt
• Manor Care of Lacey Wa, Association (ProMedica Skilled Nursing and Rehabilitation (Lacey))
• Jessica L Manzanares
• Kate Ida Marcello, LMP
• Margaret Marchand, FNP
• Aimee Anne Marchant, LMT
• Scott Marcus

• Surgical Physician Assistant in Lacey, WA
• Providers in Lacey, WA by specialty
• Surgical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.