Individual
MRS. STACIE RAE LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6000
Mailing address
2700 S 22ND ST, LEAVENWORTH, KS 66048-4059
(913) 758-3792
(913) 758-3788
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
14-100760-112
KS
Other
Enumeration date
05/11/2007
Last updated
07/08/2007
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