| NPI | 1417486655 |
|---|---|
| Former Name | STACIE LYNN NETTLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: SC 069802553) |
| Enumeration Date | 2017-06-10 |
| Last Update Date | 2017-06-10 |