Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 11001436 | FL |
NPI | 1003479189 |
---|---|
Provider Name | Ms. Stephanie Vietinghoff |
First Address | Lauderhill, FL 33351-5424 |
Second Address | Lauderdale Lakes, FL 33313-1585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2019 |
Last Update Date | 15/04/2019 |