Individual
STACI MACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
706 OAKMOUND RD, CLARKSBURG, WV 26301-9398
(304) 622-7511
Mailing address
202 BISHOP AVE, GRAFTON, WV 26354-1502
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
28011
WV
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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