Individual
DR. STACEY RENEE GOUZENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4221 TUCKASEEGEE RD, CHARLOTTE, NC 28208-2801
(704) 806-9865
Mailing address
721 CORINTHIAN PL, CHARLOTTE, NC 28211-2471
(704) 806-9865
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
23329
SC
207P00000X
Emergency Medicine Physician
Primary
9500917
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36407
BLUE CROSS
NC
05
—
8936407
—
NC
Enumeration date
05/17/2006
Last updated
11/09/2011
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