Individual
CHARLIE C STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4014 BOWER RD, ROOTSTOWN, OH 44272-9231
(330) 325-7636
Mailing address
4014 BOWER RD, ROOTSTOWN, OH 44272-9231
(330) 325-7636
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 142404
OH
Other
Enumeration date
04/06/2011
Last updated
04/06/2011
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