| NPI | 1518398403 |
|---|---|
| Former Name | STACY ANN MITTLEIDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP000831) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP000831) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2019-07-10 |