Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 102202830 | VA |
N | 207Q00000X | Family Doctor | 2548 | WV |
N | 207Q00000X | Family Doctor | 4734 | OK |
Y | 207QS0010X | Family Doctor - Sports Medicine | DO.000291 | LA |
NPI | 1083845036 |
---|---|
Provider Name | Stephanie N Aldret |
First Address | Phoenix, AZ 85023-1261 |
Second Address | Eunice, LA 70535-5135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 29/11/2016 |