| NPI | 1710990775 |
|---|---|
| Former Name | STACEY MCLELLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ME MD22365) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: ME MD22365) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2024-05-02 |