Individual
WAYNE JOE STOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1415 N 15TH ST, CANON CITY, CO 81212-4624
(719) 276-1105
Mailing address
815 GARDEN PARK RD, CANON CITY, CO 81212-8315
(719) 276-1105
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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