Individual
STACEY L. FAWBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1000 E PRIMROSE ST, SPRINGFIELD, MO 65807-5154
(417) 269-9812
(417) 269-9853
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014044284
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104215854
—
MO
Enumeration date
01/20/2015
Last updated
04/03/2019
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