Individual
SANDRA JO STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-FNP-BC
Contact information
Practice address
250 STANAFORD RD, BECKLEY, WV 25801-3140
(304) 255-2668
Mailing address
250 STANAFORD RD STE 106, BECKLEY, WV 25801-3140
(304) 255-2668
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
104460
WV
Other
Enumeration date
09/06/2019
Last updated
09/10/2019
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