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Ms. Stacy L. Dubois

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NPI Number Detailed Information

Provider Information:

Name: Ms. Stacy L. Dubois
Gender: F
Provider License Number If Given: OC005573L

NPI Information:

NPI: 1952396483
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 2/26/2020

Provider Business Mailing Address:

Address: 5930 6TH AVE STE 1
Altoona, PA 16602
Phone Number: 8145151049
Fax Number: 8145151050

Provider Business Practice Location Address:

Address: 5930 6TH AVE STE 1
Altoona, PA 16602
Phone Number: 8145151049
Fax Number: 8145151050

Provider Taxonomy:

Primary: 225X00000X
Secondary (if any):
State: PA

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