Individual
STACIE ANNE PRESTEGORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
178 RAILROAD AVE, CHEHALIS, WA 98532-9356
(360) 520-2524
Mailing address
178 RAILROAD AVE, CHEHALIS, WA 98532-9356
(360) 520-2524
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60179981
WA
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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