Individual
STACEY JEAN SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1746 LAURANCE CT, CROFTON, MD 21114-2128
(240) 461-7118
Mailing address
1746 LAURANCE CT, CROFTON, MD 21114-2128
(240) 461-7118
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R120795
MD
Other
Enumeration date
01/15/2021
Last updated
01/15/2021
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