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Individual
STACY GORDON
Active
Individual
STACY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001259955
VA
171400000X
Health & Wellness Coach
0001259955
VA
Other
Enumeration date
01/11/2024
Last updated
01/25/2024
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