Individual
STACY CWACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 MAC LN, PIERRE, SD 57501-3391
(605) 224-5901
Mailing address
208 S HARRISON AVE, PIERRE, SD 57501-3655
(605) 295-0252
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1052
SD
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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