MEDICARE: MRS. STEPHANIE ANN HOHMAN DOUGLAS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95003437	CA

General Provider Information

NPI Number	:	1487306650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE ANN HOHMAN DOUGLAS FNP-C

Provider Business Mailing Address
First Line	:	4152 KATELLA AVE STE 201
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-6608
Country	:	US
Telephone Number	:	562-598-0600
Fax Number	:	562-548-0678

Provider Business Practice Location Address
First Line	:	4152 KATELLA AVE STE 201
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-6608
Country	:	US
Telephone Number	:	562-598-0600
Fax Number	:	562-548-0678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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