Healthcare Provider Details

I. General information

NPI: 1356245823
Provider Name (Legal Business Name): STEPHANIE IDA PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

2095 SHADED KNOLL RD
CARY NC
27519-4520
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-4721
  • Fax:
Mailing address:
  • Phone: 954-662-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5025642
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: