| NPI | 1932759255 |
|---|---|
| Former Name | STACY MARIE VANDERBILT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner Women's Health (Licence: NJ 26NJ00960300) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2020-11-10 |