Individual
STACY TOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
32-36 CENTRAL AVE, WELLSBORO, PA 16901-1899
(570) 662-5395
Mailing address
482 BENAUER RD, WELLSBORO, PA 16901-7806
(570) 662-5395
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN509457L
PA
Other
Enumeration date
07/01/2025
Last updated
07/01/2025
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