| NPI | 1245794387 |
|---|---|
| Former Name | STACEY LASANDRA COLEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA 203475) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403153) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-09-16 |