Healthcare Provider Details

I. General information

NPI: 1225560022
Provider Name (Legal Business Name): STEPHANIE ALEXANDRA JOHANNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ALEXANDRA MCCLYMONT

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

9138 E 23RD AVE
DENVER CO
80238-2773
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-2575
  • Fax:
Mailing address:
  • Phone: 415-609-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0068884
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: