| NPI | 1790228765 |
|---|---|
| Former Name | STACY MOSSBERGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0006643) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006643) |
| 363A00000X Physician Assistant (Licence: GA 008199) | |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2023-03-08 |