Individual
STACY GAIL ETTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1935 MEDICAL DISTRICT DR, CENTER FOR CANCER AND BLOOD DISORDERS, DALLAS, TX 75235-7701
(214) 456-3214
Mailing address
3019 THOMAS AVE APT 1402, DALLAS, TX 75204-2814
(214) 456-3214
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
696355
TX
Other
Enumeration date
12/08/2009
Last updated
09/22/2010
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