Individual
STACY LYNN FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3851 ROGER BROOKE DR, MCHE-EMR, FORT SAM HOUSTON, TX 78234-4501
(210) 292-7626
Mailing address
8344 VERSAILLES SE RD, BRADFORD, OH 45308-9602
(937) 974-8352
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
02004134A
IN
Other
Enumeration date
05/23/2011
Last updated
05/23/2014
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