| NPI | 1841723475 |
|---|---|
| Former Name | STEPHANIE LYNN DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 58.030974) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2019-06-24 |