| NPI | 1063840759 |
|---|---|
| Former Name | STACY LYNN FETZER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004728A) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: IN 28207962A) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2014-01-22 |