| NPI | 1003104290 |
|---|---|
| Former Name | STACY LYNN MAXWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA0004352) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 6152) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2022-01-27 |