Healthcare Provider Details

I. General information

NPI: 1952933848
Provider Name (Legal Business Name): STEPHANIE DIANE MUNOZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 COURT DR STE G
GASTONIA NC
28054-3450
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-854-9990
  • Fax: 704-854-9045
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5013491
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: