Individual
STACY QUEEN DEESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.N.P
Contact information
Practice address
1540 SUNDAY DR, RALEIGH, NC 27607-6010
(919) 782-3458
(919) 420-6089
Mailing address
1540 SUNDAY DR, RALEIGH, NC 27607-6010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5005017
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7004724
—
NC
Enumeration date
12/14/2010
Last updated
09/29/2011
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