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STACEY KATHRYN PRUDICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3000 ROGERS RD STE 210, WAKE FOREST, NC 27587-5745
(919) 385-2120
Mailing address
1501 BLOOMINGDALE DR, CARY, NC 27511-5955
(919) 357-4713

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5017148
NC
363LP0200X
Pediatric Nurse Practitioner
PRUD-6TDQL
NC

Other

Enumeration date
10/28/2022
Last updated
10/29/2022
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