Healthcare Provider Details

I. General information

NPI: 1609237320
Provider Name (Legal Business Name): STEPHANIE ANN DYKALSKI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11609 SPRING CYPRESS RD UNIT C
TOMBALL TX
77377-8917
US

IV. Provider business mailing address

11609 SPRING CYPRESS RD UNIT C
TOMBALL TX
77377-8917
US

V. Phone/Fax

Practice location:
  • Phone: 281-290-6300
  • Fax: 281-290-6302
Mailing address:
  • Phone: 281-290-6300
  • Fax: 281-290-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP130016
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: