Healthcare Provider Details

I. General information

NPI: 1730329640
Provider Name (Legal Business Name): STEPHANIE L LEDL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE L SKOGLUND

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 S FREMONT AVE SUITE 1000
SPRINGFIELD MO
65804-2206
US

IV. Provider business mailing address

2055 S FREMONT AVE SUITE 1000
SPRINGFIELD MO
65804-2206
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-8099
  • Fax: 417-820-8093
Mailing address:
  • Phone: 417-820-8099
  • Fax: 417-820-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2002018100
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: