Individual
DIANE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
36 MIDDLE RD, ENFIELD, CT 06082-4533
(860) 763-5669
(860) 763-5664
Mailing address
103 WEYMOUTH RD, ENFIELD, CT 06082-6044
(860) 745-6102
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
E45917
CT
Other
Enumeration date
01/17/2007
Last updated
07/08/2007
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