Individual
STACY NICHOLE MCCORKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3214 NE EMME ST, MCMINNVILLE, OR 97128-8494
(971) 241-5628
Mailing address
3214 NE EMME ST, MCMINNVILLE, OR 97128-8494
(971) 241-5628
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2007030401LPN
OR
Other
Enumeration date
02/01/2010
Last updated
02/01/2010
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