Doctor Name: | KELSEY MARIE STACK |
NPI Number: | 1033344049 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 750 E Adams St Syracuse, NY - 132102342 |
Business Phone Number: | 3154645136 |
Business Fax Number: | |
Mailing Address: | 2850 Lafayette Rd, LA FAYETTE |
State: | NY |
Postal Code: | 130849529 |
Phone Number: | 3156778081 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2009 |
NPI Last Update Date: | 08/31/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |