Individual
ALICIA MARIE STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
432 NEW BOSTON ST, 3, CANASTOTA, NY 13032-1046
(315) 632-5097
Mailing address
432 NEW BOSTON ST, 3, CANASTOTA, NY 13032-1046
(315) 632-5097
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
319236
NY
Other
Enumeration date
08/08/2014
Last updated
08/08/2014
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