| NPI | 1124377072 |
|---|---|
| Former Name | STACI JEAN CROCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 18754) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3007660) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2014-04-11 |