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General NPI Number Information
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NPI Number | 1184342990
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Entity Type | Individual
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Provider Name | STEPHANIE NUNO
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Gender | Female
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 1023 LIPSCOMB ST STE 200
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City | FORT WORTH
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State | TX
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Zip | 76104-3102
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Country | US
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Telephone | 972-544-6600
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Fax | 972-544-6604
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Provider Business Mailing Address
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Address Line | 3600 N EDWARDS ST APT 2216
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City | MIDLAND
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State | TX
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Zip | 79705-5229
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Country | US
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Telephone | 972-997-5626
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18363
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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