Stacy Russell Henrickson ANP

NPI 1417157611 - Nurse Practitioner - 363LA2200X

NPI Details
NPI 1417157611
Gender Female
Enumeration Date 07/25/2007
Last Updated 12/03/2012
Entity Type Individual
Active Over 9 years ago
Practice Location
1090 NORTHEAST GATEWAY CT, NE
SUITE 204
CONCORD NC, 28025-2440, US
Phone (704) 403-7020
Fax (704) 403-7039
Business Location
1090 NORTHEAST GATEWAY CT, NE
SUITE 204
CONCORD NC, 28025-2440, US
Phone (704) 403-7020
Fax (704) 403-7039
Toxanomy
Taxonomy Code 363LA2200X
License State North Carolina
License Number 005003123
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According to our database, Stacy Russell Henrickson ANP NPI is 1417157611, taxonomy code is 363LA2200X and license number is 005003123, license state is located at North Carolina. Stacy Russell Henrickson ANP physically located at 1090 Northeast Gateway Ct, Ne, Concord NC, 28025-2440. NPI Number Stacy Russell Henrickson ANP has the Individual type.

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1417157611 NPI number is provided on an as is basis without warranty of any kind. 1417157611 is maintained by the National Plan & Provider Enumeration System. The contents of Stacy Russell Henrickson ANP are for informational purposes only.