NPI | 1043764467 |
---|---|
Former Name | STEPHANIE LYNN MCCRACKEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP8835) |
Enumeration Date | 2016-08-15 |
Last Update Date | 2016-12-13 |