| NPI | 1962837518 |
|---|---|
| Former Name | STACEY BROOKE VICTOR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704279344) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.14865-NP) |
| 363L00000X Nurse Practitioner (Licence: MI 4704279344) | |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2024-03-19 |