| NPI | 1528480035 |
|---|---|
| Former Name | STACIE PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 879432) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO C-APN.0100762-C-NP) |
| 363L00000X Nurse Practitioner (Licence: AZ RNP232597) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 879432) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MS 879432) | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2023-11-07 |