| NPI | 1083193965 |
|---|---|
| Former Name | STACY MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 343097) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343097) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2018-08-31 |