| NPI | 1649242025 |
|---|---|
| Former Name | STACY DIANE SHOEMAKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID M-9953) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A68685) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA MD00049170) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2011-04-21 |