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General NPI Number Information
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NPI Number | 1124455118
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Entity Type | Individual
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Provider Name | STACYE DICK GNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 14121 PARKE LONG CT SUITE 200 & 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 571-449-3585
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Fax | 800-752-2471
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Provider Business Mailing Address
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Address Line | 14121 PARKE LONG CT SUITE 200 & 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 571-449-3585
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Fax | 800-752-2471
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 256896
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License Number State | TX
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