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Individual
STACY ELAINE NEUDORF
Active
Individual
STACY ELAINE NEUDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10708
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96877553
—
NM
Enumeration date
05/08/2012
Last updated
10/18/2016
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