Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 082172 | LA |
NPI | 1003818287 |
---|---|
Provider Name | Jeffrey J Stein |
First Address | Slidell, LA 70458-2949 |
Second Address | Covington, LA 70433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 13/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1113174 | (05) | LA |
P53008 | (02) |