MEDICARE: MS. STEPHANIE HELENE TATALOS RN, WHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	455586	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1629071162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE HELENE TATALOS RN, WHNP-BC

Provider Business Mailing Address
First Line	:	2821 NEWPORT AVE
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-4719
Country	:	US
Telephone Number	:	940-566-5244
Fax Number	:

Provider Business Practice Location Address
First Line	:	3537 S I-35 E
Second Line	:	STE 210
City	:	DENTON
State	:	TX
Zip	:	76210-6800
Country	:	US
Telephone Number	:	940-381-2313
Fax Number	:	940-381-5249

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	01/29/2013

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