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General NPI Number Information
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NPI Number | 1285403030
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Entity Type | Individual
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Provider Name | STEPHANIE STREET RN
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Gender | Female
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 2745 HARNEY PATH STE 187
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City | JBSA FT SAM HOUSTON
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State | TX
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Zip | 78234-7678
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Country | US
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Telephone | 210-221-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 WHEATON RD
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City | JBSA FSH
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State | TX
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Zip | 78234-2673
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Country | US
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Telephone | 715-781-5742
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1967566
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 262268-30
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 14937-33
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 652
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License Number State | MN
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