Healthcare Provider Details

I. General information

NPI: 1427683275
Provider Name (Legal Business Name): STEPHANIE MARIE LOBRECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14041 NORTHWEST BLVD STE 1
CORPUS CHRISTI TX
78410-5138
US

IV. Provider business mailing address

277 BUDDY GANEM DR STE A
PORTLAND TX
78374-3202
US

V. Phone/Fax

Practice location:
  • Phone: 361-767-9963
  • Fax:
Mailing address:
  • Phone: 361-777-3900
  • Fax: 361-413-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP144311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: