| NPI | 1053430876 |
|---|---|
| Former Name | STACIE MERRITT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ AZ 5154) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004376) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2014-07-02 |