Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 19987 | TN |
NPI | 1356722516 |
---|---|
Provider Name | Mrs. Stacy Nichole Basinger |
First Address | Cullman, AL 35055-9096 |
Second Address | Cullman, AL 35055-9096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2015 |
Last Update Date | 13/06/2015 |