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Individual

STACEY MARIE BAST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
223 GARDEN ST, EDWARDSVILLE, IL 62025-1974
(314) 420-9576
Mailing address
153 CHESTER ST, CHESTER, IL 62233-1755
(618) 559-3482

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043-087181
IL

Other

Enumeration date
10/13/2019
Last updated
10/13/2019
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