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General NPI Number Information
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NPI Number | 1598229270
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN WHITE HIS
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Gender | Female
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Dates
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Enumeration Date | 01/26/2019
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Last Update Date | 01/26/2019
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Provider Practice Location Address
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Address Line | 802 NW SHERIDAN RD
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City | LAWTON
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State | OK
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Zip | 73505-5296
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Country | US
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Telephone | 405-759-0472
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Fax |
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Provider Business Mailing Address
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Address Line | 107 W HARPER
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City | FLETCHER
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State | OK
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Zip | 73541-2006
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Country | US
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Telephone | 580-585-1887
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 001240
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License Number State | OK
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