Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 23497 | SC |
NPI | 1063032316 |
---|---|
Provider Name | Ms. Tracy Stichert |
First Address | Aiken, SC 29801-3937 |
Second Address | Aiken, SC 29801-3937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2020 |
Last Update Date | 22/08/2021 |