| NPI | 1437429388 |
|---|---|
| Former Name | STACIA SUNDERLAND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-113123) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: NM PA2019-0026) | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2024-02-19 |