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Individual
MR. STACY LEN WHITZELL
Active
Individual
MR. STACY LEN WHITZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
1000000016408
TN
3747P1801X
Personal Care Attendant
1000000016408
TN
Other
Enumeration date
07/19/2015
Last updated
07/19/2015
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