| NPI | 1649636101 |
|---|---|
| Former Name | STACIE RILEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000905) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0036765) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2016-01-13 |