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Individual

MARY R. STACKHOUSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.N.

Contact information

Practice address
905 W GREENWOOD ST, ABBEVILLE, SC 29620-5678
(864) 366-2131
(864) 366-4105
Mailing address
PO BOX 189, ABBEVILLE, SC 29620-0189
(864) 366-2131
(864) 366-4105

Taxonomy

Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R 42648
SC

Other

Enumeration date
04/14/2014
Last updated
04/14/2014
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