| NPI | 1013300896 |
|---|---|
| Former Name | STACEY MUIR WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3009247) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009247) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2024-12-02 |