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General NPI Number Information
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NPI Number | 1386148252
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Entity Type | Individual
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Provider Name | WAYNE ALLEN STEPHENSON
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1751 NE PINE ISLAND RD STE 140
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City | CAPE CORAL
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State | FL
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Zip | 33909-1773
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Country | US
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Telephone | 239-677-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 WASHINGTON AVE S
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3405
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Country | US
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Telephone | 612-351-1529
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Fax | 952-285-3980
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 5347
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 5347
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License Number State | FL
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