Healthcare Provider Details

I. General information

NPI: 1770366346
Provider Name (Legal Business Name): STEPHANIE KREUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2247 E MEAD PL
CHANDLER AZ
85249-3266
US

IV. Provider business mailing address

2247 E MEAD PL
CHANDLER AZ
85249-3266
US

V. Phone/Fax

Practice location:
  • Phone: 602-743-9236
  • Fax:
Mailing address:
  • Phone: 602-743-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: