Individual
STACY PENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS, LDN
Contact information
Practice address
612 DEERFIELD POND CT, GREAT FALLS, VA 22066-2830
(703) 728-6216
Mailing address
612 DEERFIELD POND CT, GREAT FALLS, VA 22066-2830
(703) 728-6216
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
DX5561
MD
133NN1002X
Nutrition Education Nutritionist
DX5561
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DX5561
MARYLAND DEPARTMENT OF HEALTH
MD
Enumeration date
02/14/2022
Last updated
02/14/2022
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