Individual
CAROL STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
ANNA MARSH LANE, BRATTLEBORO, VT 05302
(802) 257-7785
Mailing address
ANNA MARSH LANE, BRATTLEBORO, VT 05302
(802) 257-7785
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
101-00112255
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101-0011225
LICENSE
VT
Enumeration date
09/12/2006
Last updated
09/05/2008
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