Most Relevant Information
Provider Data
| NPI Number: | 1003223934 |
| Provider Name: | STACEY GLASS MALSTROM NP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | RN177773 |
Most Important Dates
| Enumeration Date: | 07/11/2014 |
| Last Updated: | 07/16/2020 |
Provider Practice Location
55 WHITCHER ST NE STE 350
MARIETTA
GA
300601129
Practice Location Phone/Fax
| Phone: | 7704246893 |
| Fax: |
Provider Mailing Location
55 WHITCHER ST NE STE 350
MARIETTA
GA
300601129
Provider Mailing Phone/Fax
| Phone: | 7704246893 |
| Fax: |