| NPI | 1720616873 |
|---|---|
| Former Name | STEPHANIE ANN BURNHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024179867) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001244829) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2021-12-21 |