| NPI | 1174056766 |
|---|---|
| Former Name | STACY LYNN BLANK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: TN 63671) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-06-25 |