Healthcare Provider Details

I. General information

NPI: 1649755919
Provider Name (Legal Business Name): STEPHANIE LYNN ONDATJE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN BROWN FNP

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/16/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E PRIMROSE ST
SPRINGFIELD MO
65807-5155
US

IV. Provider business mailing address

PO BOX 9007
SPRINGFIELD MO
65808-9007
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3000
  • Fax:
Mailing address:
  • Phone: 417-875-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018034792
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: