| NPI | 1235325051 |
|---|---|
| Former Name | JODY RUTH STAGG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 62704) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WV 62704) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024183184) | |
| Enumeration Date | 2007-09-16 |
| Last Update Date | 2022-06-13 |