STACEY MARIE BAST

EDWARDSVILLE, IL
NPI1578105367
Professional NameSTACEY MARIE COFFEY
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy164W00000X Licensed Practical Nurse
(Licence: IL  043-087181)
Enumeration Date2019-10-13
Last Update Date2019-10-13
Business Address
STACEY MARIE BAST
223 GARDEN ST
EDWARDSVILLE, IL 62025-1974
Phone number: 314-420-9576
Mailing Address
STACEY MARIE BAST
153 CHESTER ST
CHESTER, IL 62233-1755
Phone number: 618-559-3482