1245418425 NPI number — MRS. STEPHANIE KAY MCMULLEN CSW INTERN

Table of content: MRS. STEPHANIE KAY MCMULLEN CSW INTERN (NPI 1245418425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245418425 NPI number — MRS. STEPHANIE KAY MCMULLEN CSW INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMULLEN
Provider First Name:
STEPHANIE
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CSW INTERN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KORF
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW, MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245418425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7475 LA COSTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89436-6425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-770-8505
Provider Business Mailing Address Fax Number:
775-334-3022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
745 W MOANA LN
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-4932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-334-3033
Provider Business Practice Location Address Fax Number:
775-334-3022
Provider Enumeration Date:
02/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  4655-S , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: IC987 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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