| Doctor Name: | STACYE DICK |
| NPI Number: | 1124455118 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | GNP-BC |
| License Number: | 256896 |
| Business Practice Address: | 14121 Parke Long Ct Suite 200 & 201 Chantilly, VA - 201511647 |
| Business Phone Number: | 5714493585 |
| Business Fax Number: | 8007522471 |
| Mailing Address: | 14121 Parke Long Ct, Suite 200 & 201 CHANTILLY |
| State: | VA |
| Postal Code: | 201511647 |
| Phone Number: | 5714493585 |
| Fax Number: | 8007522471 |
| NPI Enumeration Date: | 10/04/2013 |
| NPI Last Update Date: | 10/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 256896 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |