| NPI | 1528098712 |
|---|---|
| Former Name | STACEY ELLEN BURGIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005457) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP14812) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-11-13 |