Individual
STACIE WALSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4252 158TH ST # 2, FLUSHING, NY 11358-2509
(631) 926-0127
Mailing address
4252 158TH ST # 2, FLUSHING, NY 11358-2509
(631) 926-0127
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
724592
NY
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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