NPI | 1265687198 |
---|---|
Former Name | STACEY MARIE CORYELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C2-0023949) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB08910400) |
Enumeration Date | 2008-11-19 |
Last Update Date | 2024-05-23 |