Healthcare Provider Details

I. General information

NPI: 1689695330
Provider Name (Legal Business Name): STEPHANIE S MARANGONI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4092 FOXWOOD DR SUITE 101
VIRGINIA BEACH VA
23462-5225
US

IV. Provider business mailing address

PO BOX 7549
PORTSMOUTH VA
23707-0549
US

V. Phone/Fax

Practice location:
  • Phone: 757-467-4200
  • Fax:
Mailing address:
  • Phone: 757-686-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001069819
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024069819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: