Individual
STACEY WEBSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10400 NOKESVILLE RD, MANASSAS, VA 20110-4141
(720) 771-7623
Mailing address
10302 FOREST AVE, FAIRFAX, VA 22030-3530
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126003162
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BOC110728
BOC
—
Enumeration date
02/24/2020
Last updated
02/24/2020
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