Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | F320014 | NY |
NPI | 1063414621 |
---|---|
Provider Name | Ms. Barbara Frances Stack |
First Address | Blooming Grove, NY 10914-0056 |
Second Address | New Windsor, NY 12553-8549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 08/07/2007 |