| NPI | 1649658907 |
|---|---|
| Former Name | STEPHANIE NICOLE ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R3763) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 29772) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2019-08-28 |