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General NPI Number Information
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NPI Number | 1083702716
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Entity Type | Individual
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Provider Name | STEPHANIE LOUISE HERRICK FNP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 1987 MCCULLOCH BLVD N STE 101
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5682
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Country | US
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Telephone | 928-453-6963
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Fax | 928-453-7011
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Provider Business Mailing Address
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Address Line | 1988 SPRUCE DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-7514
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Country | US
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Telephone | 928-575-6713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP328
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License Number State | AZ
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