Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 11642 | NH |
NPI | 1275636235 |
---|---|
Provider Name | Jennifer Katsu Stebbing |
First Address | Rye, NH 03870-2055 |
Second Address | Portsmouth, NH 03801-5437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11642 | LICENSE (01) | NH |
G81699 | (02) |