| NPI | 1558052597 |
|---|---|
| Former Name | STACY SHANETTE GHOLSTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2025-06-19 |