| NPI | 1982288486 |
|---|---|
| Other Name | STACIE RENE DE JESUS HENDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13182462-1206) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2023-03-09 |