Individual
RACHAEL MARY STACOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1770 GRAND CONCOURSE, SUITE 2G, BRONX, NY 10457-5524
(718) 393-7617
Mailing address
37 E 83RD ST, APT 1, NEW YORK, NY 10028-0813
(212) 744-6731
(212) 995-5016
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
304736
NY
Other
Enumeration date
02/21/2008
Last updated
02/21/2008
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