| NPI | 1326019738 |
|---|---|
| Former Name | PENNY L STAVLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2010) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R115129-1) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-08-10 |