Healthcare Provider Details

I. General information

NPI: 1437594678
Provider Name (Legal Business Name): STEPHANIE J KLEE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 10/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 EL GRANADA BLVD
HALF MOON BAY CA
94019-4851
US

IV. Provider business mailing address

188 EL GRANADA BLVD
HALF MOON BAY CA
94019
US

V. Phone/Fax

Practice location:
  • Phone: 650-283-8392
  • Fax:
Mailing address:
  • Phone: 650-283-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23153
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number445231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: