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General NPI Number Information
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NPI Number | 1881857480
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Entity Type | Individual
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Provider Name | STEPHANIE C PENICK MIDWIFE
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Gender | Female
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 5824 E 10TH AVE
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City | APACHE JUNCTION
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State | AZ
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Zip | 85219-9318
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Country | US
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Telephone | 480-982-0718
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Fax | 480-982-0718
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Provider Business Mailing Address
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Address Line | 5824 E 10TH AVE
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City | APACHE JUNCTION
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State | AZ
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Zip | 85219
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Country | US
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Telephone | 480-982-0718
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Fax | 480-982-0718
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | 60
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License Number State | AZ
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