| NPI | 1295152189 |
|---|---|
| Former Name | STACEE LYNN GOEDTEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 65320-21) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2017-06-30 |