Individual
MRS. MARY BRUCE STALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1027 CLARK ST, BIRMINGHAM, MI 48009-3630
(704) 880-4054
Mailing address
1027 CLARK ST, BIRMINGHAM, MI 48009-3630
(704) 880-4054
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704298881
MI
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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