| NPI | 1326769498 |
|---|---|
| Former Name | STACIE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 13149-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 235881-30) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 13149) | |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2025-10-13 |