| 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 |