Individual
MRS. STACEY JANNETTE BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, RN, PNP
Contact information
Practice address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 997-3000
Mailing address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 997-3000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
583021
CA
Other
Enumeration date
09/11/2012
Last updated
09/11/2012
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