Individual
WAYNE ANTHONY STACKHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3213 N 27TH ST, PHILADELPHIA, PA 19129-1808
(267) 742-4163
(267) 742-4163
Mailing address
3213 N 27TH ST, PHILADELPHIA, PA 19129-1808
(267) 742-4163
(267) 742-4163
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
PA
Other
Enumeration date
07/14/2025
Last updated
07/14/2025
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