1750621637 NPI number — MS. STEPANIE EVETTE DUNN PLMSW

Table of content: MS. STEPANIE EVETTE DUNN PLMSW (NPI 1750621637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750621637 NPI number — MS. STEPANIE EVETTE DUNN PLMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNN
Provider First Name:
STEPANIE
Provider Middle Name:
EVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PLMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750621637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3625 YOUREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71105-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 E NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNFIELD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71483-3276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-628-1505
Provider Business Practice Location Address Fax Number:
318-628-1506
Provider Enumeration Date:
02/28/2013

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 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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