Individual
DR. COLLEEN MARIE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
137 MEDICAL LN, POLLOCKSVILLE, NC 28573-8200
(252) 633-1010
(252) 224-3071
Mailing address
PO BOX 68, POLLOCKSVILLE, NC 28573-0068
(252) 635-3906
(252) 224-0378
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2019-01393
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2014
Last updated
07/03/2019
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