Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 16688 | CA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 16688 | CA |
NPI | 1023200946 |
---|---|
Provider Name | Shannan Ann Stephenson |
First Address | Torrance, CA 90502-2004 |
Second Address | Torrance, CA 90502-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |