Individual
JEANIE MARIE STAKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2802 FOX CREEK TRL, ARLINGTON, TX 76017-7960
(817) 475-0341
Mailing address
2802 FOX CREEK TRL, ARLINGTON, TX 76017-7960
(817) 475-0341
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
578467
TX
Other
Enumeration date
03/12/2018
Last updated
03/17/2018
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