Healthcare Provider Details

I. General information

NPI: 1144839440
Provider Name (Legal Business Name): STEPHANIE GARRETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE QUEENEN

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355-2001
US

IV. Provider business mailing address

34665 DESERT RD
ACTON CA
93510-2813
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-8000
  • Fax:
Mailing address:
  • Phone: 661-209-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: