Doctor Name: | MARY JAEGER STACY |
NPI Number: | 1790741072 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 101-0019775 |
Business Practice Address: | 5957 Main St Northshire Medical Center Manchester Center, VT - 052558913 |
Business Phone Number: | 8023624440 |
Business Fax Number: | 8023627146 |
Mailing Address: | 5957 Main Street, Northshire Medical Center MANCHESTER |
State: | VT |
Postal Code: | 05255 |
Phone Number: | 8023624440 |
Fax Number: | 8023627146 |
NPI Enumeration Date: | 04/25/2006 |
NPI Last Update Date: | 01/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 101-0019775 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |