NPI | 1174079917 |
---|---|
Former Name | STACY ANN TANDESKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP4566) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 4566) |
Enumeration Date | 2016-08-31 |
Last Update Date | 2023-05-22 |