| NPI | 1235875675 |
|---|---|
| Former Name | STACEY MARIE BURDETTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 72224) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-05-09 |