| NPI | 1215217096 |
|---|---|
| Former Name | STACEY SEASTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0054787) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL UO2794) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CO DR.0054787) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2015-09-15 |