MEDICARE: MISS STEPHANIE W CONN P.A.C.

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
1	363AM0700X	Medical Physician Assistant	PA 9105004	FL
2	363AM0700X	Medical Physician Assistant	PA030914	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA 9105004	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1821226754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE W CONN P.A.C.

Provider Business Mailing Address
First Line	:	130 SUTTER ST 2
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-4009
Country	:	US
Telephone Number	:	415-658-6791
Fax Number	:	415-520-0904

Provider Business Practice Location Address
First Line	:	1627 EYE ST NW
Second Line	:	SUITE 800
City	:	WASHINGTON
State	:	DC
Zip	:	20006-4007
Country	:	US
Telephone Number	:	202-660-0025
Fax Number	:	202-660-0015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	10/14/2016

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