| NPI | 1881702298 |
|---|---|
| Former Name | STACY STATLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 1501310) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA003020L) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2020-11-24 |