| NPI | 1508122938 |
|---|---|
| Former Name | STEPHANIE RENEE SUPRENANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MT 70012) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 62485) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2023-09-06 |