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NPI Code Detail

MEDICARE: STEPHANIE L REDWINE RDH, BS

MEDICARE: STEPHANIE L REDWINE RDH, BS
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
1124Q00000XDental Hygienist3626NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548322191
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE L REDWINE RDH, BS
Provider Business Mailing Address
First Line : 3074 ARVILLE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-7490
Country : US
Telephone Number : 702-889-3763
Fax Number :
Provider Business Practice Location Address
First Line : 3074 ARVILLE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-7490
Country : US
Telephone Number : 702-889-3763
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 03/09/2012

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