Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LMW0090 | SC |
NPI | 1073133716 |
---|---|
Provider Name | Mrs. Stacey Pouliot |
First Address | Charlotte, NC 28269-9174 |
Second Address | Charlotte, NC 28269-9174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2020 |
Last Update Date | 22/04/2020 |