Individual
STACEY LYNN PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
56 N BROADWAY, 2S, YONKERS, NY 10701-7036
(646) 335-8979
Mailing address
56 N BROADWAY, 2S, YONKERS, NY 10701-7036
(646) 335-8979
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
NY000429189E
NY
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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