| NPI | 1316206196 |
|---|---|
| Other Name | STEPHANIE NICOLE HISTED |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA11046400) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2022-04-05 |