| Doctor Name: | BRENDA STACK |
| NPI Number: | 1164851259 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | SP013188 |
| Business Practice Address: | 132 Colonial Dr Towanda, PA - 188488107 |
| Business Phone Number: | 5702656165 |
| Business Fax Number: | 5702653616 |
| Mailing Address: | 1 Guthrie Sq, SAYRE |
| State: | PA |
| Postal Code: | 188401625 |
| Phone Number: | 5708885858 |
| Fax Number: | |
| NPI Enumeration Date: | 11/08/2013 |
| NPI Last Update Date: | 09/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | SP013188 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |