Healthcare Provider Details

I. General information

NPI: 1427222009
Provider Name (Legal Business Name): STEPHANIE SUTPHEN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CROSSWICKS RD STE 11
BORDENTOWN NJ
08505-2602
US

IV. Provider business mailing address

231 CROSSWICKS RD STE 11
BORDENTOWN NJ
08505-2602
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-7204
  • Fax: 609-298-0491
Mailing address:
  • Phone: 609-298-7204
  • Fax: 609-298-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN07722100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: