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Individual
BRENDA STACK
Active
Individual
BRENDA STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP013188
PA
364SF0001X
Family Health Clinical Nurse Specialist
SP013188
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP013188
CRNP LICENSE #
PA
Enumeration date
11/08/2013
Last updated
03/05/2021
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