| NPI | 1821339151 |
|---|---|
| Former Name | STACEY FERGUSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA-055904) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055904) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2023-04-18 |