Individual
STACY KUCHARCZK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1735 CITY CENTER BLVD, ELIZABETH CITY, NC 27909-8960
(252) 338-2155
(252) 338-7704
Mailing address
1735 CITY CENTER BLVD, ELIZABETH CITY, NC 27909-8960
(252) 338-2155
(252) 338-7704
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5004933
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28859N
OPTIMA, OFC,FAMIS
VA
01
—
541778786
NC HEALTH CH
NC
05
—
7787758
—
VA
Enumeration date
07/17/2006
Last updated
12/11/2012
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