Individual
BETHANY LYNN STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
3 ALBERT CREE DR, RUTLAND, VT 05701-4601
(802) 775-2937
(802) 773-0934
Mailing address
3 ALBERT CREE DR, RUTLAND, VT 05701-4601
(802) 775-2937
(802) 773-0934
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055-0030670
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00059907
BCBS
VT
Enumeration date
09/19/2005
Last updated
03/03/2011
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