Individual
STACIA QUACKENBOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
275 GLENN ALLEN RD, MOORESVILLE, NC 28115-5811
(727) 710-7330
Mailing address
275 GLENN ALLEN RD, MOORESVILLE, NC 28115-5811
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
378847
NC
Other
Enumeration date
03/11/2026
Last updated
03/11/2026
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