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Individual
ANDREW ROGER STACEY
Active
Individual
ANDREW ROGER STACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704292793
MI
363LA2100X
Acute Care Nurse Practitioner
4704292793
MI
Other
Enumeration date
07/09/2018
Last updated
12/13/2018
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