1881857480 NPI number — MS. STEPHANIE C PENICK MIDWIFE

Table of content: MS. STEPHANIE C PENICK MIDWIFE (NPI 1881857480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881857480 NPI number — MS. STEPHANIE C PENICK MIDWIFE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENICK
Provider First Name:
STEPHANIE
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MIDWIFE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEPULVEDA
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881857480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5824 E 10TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APACHE JUNCTION
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-982-0718
Provider Business Mailing Address Fax Number:
480-982-0718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5824 E 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APACHE JUNCTION
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85219-9318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-982-0718
Provider Business Practice Location Address Fax Number:
480-982-0718
Provider Enumeration Date:
07/03/2008

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: 176B00000X , with the licence number:  60 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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