MEDICARE: STEPHANIE MICHELLE NAUERT PA-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	363AS0400X	Surgical Physician Assistant		TX

General Provider Information

NPI Number	:	1730427279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MICHELLE NAUERT PA-C

Provider Business Mailing Address
First Line	:	1924 PINE ST STE 504
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-2452
Country	:	US
Telephone Number	:	325-670-4730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 PINE ST STE 504
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-2452
Country	:	US
Telephone Number	:	325-670-4730
Fax Number	:

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

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	07/31/2013

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