| NPI | 1164626826 |
|---|---|
| Former Name | STACIA A FALLERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209015810) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: IL 041346618) |
| 363L00000X Nurse Practitioner (Licence: IL 209015810) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2022-08-16 |