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Individual

STACY STATS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNS

Contact information

Practice address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(760) 637-7813
Mailing address
15001 PANSY CT, WOODBRIDGE, VA 22193-3385
(760) 637-7813

Taxonomy

Speciality
Code
Description
License number
State
364SC0200X
Critical Care Medicine Clinical Nurse Specialist
Primary
4515
CA

Other

Enumeration date
09/07/2022
Last updated
09/07/2022
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