Healthcare Provider Details

I. General information

NPI: 1376998542
Provider Name (Legal Business Name): STEPHANIE ROMNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 FINCH ISLAND AVE
HENDERSON NV
89015-6638
US

IV. Provider business mailing address

685 FINCH ISLAND AVE
HENDERSON NV
89015-6638
US

V. Phone/Fax

Practice location:
  • Phone: 801-706-4859
  • Fax:
Mailing address:
  • Phone: 801-706-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number27-2855118
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: