Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5004828 | NC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5004828 | NC |
NPI | 1093021461 |
---|---|
Provider Name | Cheryl Anne Stacy |
First Address | Newton, NC 28658-9715 |
Second Address | Newton, NC 28658-9715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2010 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7004558 | (05) | NC |