Healthcare Provider Details

I. General information

NPI: 1376523258
Provider Name (Legal Business Name): STEPHANIE RAE MASTNY APRN C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N HOWARD AVE STE 109
GRAND ISLAND NE
68803-3529
US

IV. Provider business mailing address

2530 NORTH SHERIDAN AVE
GRAND ISLAND NE
68803
US

V. Phone/Fax

Practice location:
  • Phone: 308-380-3498
  • Fax:
Mailing address:
  • Phone: 308-398-5522
  • Fax: 308-398-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110402
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number49832
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: