| NPI | 1831516160 |
|---|---|
| Former Name | STEPHANIE KAY ANDERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64588-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2022-07-21 |