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General NPI Number Information
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NPI Number | 1386443588
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Entity Type | Individual
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Provider Name | MS. DALLAS NICOLE STEPHENS
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2550 LAWLOR RD
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City | FAIRBANKS
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State | AK
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Zip | 99709-6458
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Country | US
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Telephone | 907-452-8251
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Fax | 907-459-3810
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Provider Business Mailing Address
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Address Line | 122 1ST AVE STE 400
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City | FAIRBANKS
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State | AK
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Zip | 99701-4871
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Country | US
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Telephone | 907-452-8251
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Fax | 907-459-3810
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | AK
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