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NPI Code Detail

MEDICARE: STEPHANIE MARIE PLACE FNP

MEDICARE: STEPHANIE MARIE PLACE FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner5010727NC

General Provider Information

NPI Number : 1366917999
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MARIE PLACE FNP
Provider Business Mailing Address
First Line : 317 WESTERN BLVD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-6379
Country : US
Telephone Number : 910-577-2345
Fax Number :
Provider Business Practice Location Address
First Line : 317 WESTERN BLVD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-6379
Country : US
Telephone Number : 910-577-2345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 10/10/2018

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