Healthcare Provider Details

I. General information

NPI: 1659634582
Provider Name (Legal Business Name): STEPHANIE C WHITING RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W WILLOW ST BLDG A
LAFAYETTE LA
70501-2837
US

IV. Provider business mailing address

220 W WILLOW ST BLDG A
LAFAYETTE LA
70501-2837
US

V. Phone/Fax

Practice location:
  • Phone: 337-262-5616
  • Fax:
Mailing address:
  • Phone: 337-262-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN048514
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: