Individual
DERICA STAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
120 BULL STRING LN, GREENUP, KY 41144-6175
(606) 922-8207
Mailing address
120 BULL STRING LN, GREENUP, KY 41144-6175
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
156627
OH
Other
Enumeration date
12/09/2021
Last updated
12/09/2021
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