Healthcare Provider Details

I. General information

NPI: 1780117663
Provider Name (Legal Business Name): STEPHANIE TOWNSEND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81719 DR CARREON BLVD STE A
INDIO CA
92201-5518
US

IV. Provider business mailing address

81719 DR CARREON BLVD STE A
INDIO CA
92201-5518
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-0707
  • Fax: 760-347-3378
Mailing address:
  • Phone: 760-347-0707
  • Fax: 760-347-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number540304
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: