| NPI | 1710968763 |
|---|---|
| Former Name | STACEY ORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0622) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AZ 2511) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2022-09-30 |