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Individual

BRENDA STACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP013188
PA
364SF0001X
Family Health Clinical Nurse Specialist
SP013188
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
SP013188
CRNP LICENSE #
PA
Enumeration date
11/08/2013
Last updated
03/05/2021
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