Healthcare Provider Details

I. General information

NPI: 1386303766
Provider Name (Legal Business Name): STEFANIE BISCHOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL PKWY
CARSON CITY NV
89703-4625
US

IV. Provider business mailing address

790 ROJO WAY
GARDNERVILLE NV
89460-7544
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-8653
  • Fax:
Mailing address:
  • Phone: 408-612-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN79378
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: