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General NPI Number Information
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NPI Number | 1417304221
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Entity Type | Individual
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Provider Name | STEPHANIE HUNTSMAN MED, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/21/2016
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Last Update Date | 05/21/2016
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Provider Practice Location Address
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Address Line | 980 KELLY JOHNSON DR SUITE 200
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City | LAS VEGAS
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State | NV
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Zip | 89119-3785
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Country | US
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Telephone | 702-352-0026
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Fax |
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Provider Business Mailing Address
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Address Line | 9616 LIGHTHEART AVE
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City | LAS VEGAS
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State | NV
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Zip | 89148-5517
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Country | US
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Telephone | 703-819-4414
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0506370
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126001746
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0001085
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License Number State | CO
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