Individual
JESSICA STACO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
U
Contact information
Practice address
16 MAIN ST, HEMPSTEAD, NY 11550-4020
(516) 489-2322
Mailing address
PO BOX 111, VALLEY STREAM, NY 11582-0111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
672206
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403618
NY
Other
Enumeration date
12/16/2013
Last updated
06/20/2024
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