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Individual
MS. MARY BETH STACK
Active
Individual
MS. MARY BETH STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001096552
VA
363L00000X
Nurse Practitioner
Primary
0024096552
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500029674
RAILROAD
—
01
—
C07038
CMS GROUP
—
Enumeration date
10/26/2006
Last updated
01/06/2015
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