Healthcare Provider Details

I. General information

NPI: 1881388742
Provider Name (Legal Business Name): STEPHANIE NICOLE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GEER RD STE 120
TURLOCK CA
95382-2456
US

IV. Provider business mailing address

1436 HACKETT RD
CERES CA
95307-9572
US

V. Phone/Fax

Practice location:
  • Phone: 209-664-8044
  • Fax:
Mailing address:
  • Phone: 406-899-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95331301
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95331301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: