| NPI | 1902101231 |
|---|---|
| Former Name | STACEY WALDO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA054789) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2023-06-22 |