| NPI | 1487624607 |
|---|---|
| Former Name | STACY ANN NICHOLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 18698) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-34598) |
| 208000000X Pediatrics (Licence: VA 0101245035) | |
| 208000000X Pediatrics (Licence: FL ME111597) | |
| 208000000X Pediatrics (Licence: NE 21188) | |
| 208000000X Pediatrics (Licence: IN 01049920A) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2019-02-06 |