Healthcare Provider Details

I. General information

NPI: 1912089087
Provider Name (Legal Business Name): STEPHANIE DALE STORY N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 ANGLER LN
VIRGINIA BEACH VA
23451-6513
US

IV. Provider business mailing address

1047 ANGLER LN
VIRGINIA BEACH VA
23451-6513
US

V. Phone/Fax

Practice location:
  • Phone: 757-428-7979
  • Fax: 757-747-0485
Mailing address:
  • Phone: 757-428-7979
  • Fax: 757-747-0485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: