Healthcare Provider Details

I. General information

NPI: 1194663286
Provider Name (Legal Business Name): STEFANIE NANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HERTFORD LN
GRAHAM NC
27253-4444
US

IV. Provider business mailing address

608 HERTFORD LN
GRAHAM NC
27253-4444
US

V. Phone/Fax

Practice location:
  • Phone: 336-260-1525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: