Healthcare Provider Details

I. General information

NPI: 1558040220
Provider Name (Legal Business Name): STEPHANIE STRICKLAND FNP-BC/C, RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE POGRUND

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARCELA DR STE C
WILLITS CA
95490-5769
US

IV. Provider business mailing address

3 MARCELA DR STE C
WILLITS CA
95490-5769
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-6115
  • Fax:
Mailing address:
  • Phone: 707-459-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: