Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 11968631-1204 | UT |
NPI | 1255743639 |
---|---|
Provider Name | Dr. Stephanie Marie Manberg |
First Address | Phoenix, AZ 85020-3669 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 20/11/2021 |