Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 657 | NV |
NPI | 1154388072 |
---|---|
Provider Name | Lone Birgit Stephens |
First Address | Page, AZ 86040-1625 |
Second Address | Littlefield, AZ 86432-0490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
096750 | (05) | AZ |
Q10583 | (02) |