| NPI | 1285008227 |
|---|---|
| Former Name | STACEY ALETHEA WAGGONER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 0083425) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 83425) |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2019-01-09 |