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General NPI Number Information
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NPI Number | 1356873608
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Entity Type | Individual
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Provider Name | DARLENE M STEPHENSON RN, RDCS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 374 STUART DR
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City | INKOM
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State | ID
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Zip | 83245-0394
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Country | US
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Telephone | 208-775-3783
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Fax | 208-417-0267
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Provider Business Mailing Address
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Address Line | PO BOX 394 374 STUART DR
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City | INKOM
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State | ID
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Zip | 83245-0394
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Country | US
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Telephone | 208-775-3783
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Fax | 208-417-0267
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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 | N14975
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License Number State | ID
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