Healthcare Provider Details

I. General information

NPI: 1962730226
Provider Name (Legal Business Name): MISS STEPHANIE MICHELLE JOYNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS STEPHANIE MICHELLE JOYNER

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 PULASKI AVE
PHILADELPHIA PA
19140-3540
US

IV. Provider business mailing address

3858 PULASKI AVE
PHILADELPHIA PA
19140-3540
US

V. Phone/Fax

Practice location:
  • Phone: 215-837-3304
  • Fax: 215-228-9194
Mailing address:
  • Phone: 215-837-3304
  • Fax: 215-228-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number9609430
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number9609430
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number9609430
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: