Healthcare Provider Details

I. General information

NPI: 1760564637
Provider Name (Legal Business Name): STEPHANIE NICOLE HUHN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. STEPHANIE NICOLE BROOKS

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 S BISHOP AVE STE A
ROLLA MO
65401-4333
US

IV. Provider business mailing address

1028 S. BISHOP AVE PMB 201
ROLLA MO
65401
US

V. Phone/Fax

Practice location:
  • Phone: 573-995-2213
  • Fax: 573-240-9752
Mailing address:
  • Phone: 573-995-2213
  • Fax: 573-240-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013030154
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: