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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | Martin, Stacy | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1992763569 | [sources] | |||
| Sector | Ind-Lic HC Serv Prov - Nurse Practitioner | [sources] | |||
| Status | not available | [sources] | |||
| Address | Blacksburg, SC 29702 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers excluded from South Carolina's Medicaid program.
United States of America · SCDHHS
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