Healthcare Provider Details

I. General information

NPI: 1881857480
Provider Name (Legal Business Name): STEPHANIE C PENICK MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE C SEPULVEDA LM

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5824 E 10TH AVE
APACHE JUNCTION AZ
85219-9318
US

IV. Provider business mailing address

5824 E 10TH AVE
APACHE JUNCTION AZ
85219
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-0718
  • Fax: 480-982-0718
Mailing address:
  • Phone: 480-982-0718
  • Fax: 480-982-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number60
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: