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NPI Code Detail

MEDICARE: BRANDELEIN MARIE STEFONEK

MEDICARE: BRANDELEIN MARIE STEFONEK
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
1363L00000XNurse Practitioner236599AR

General Provider Information

NPI Number : 1902749880
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDELEIN MARIE STEFONEK
Provider Business Mailing Address
First Line : 308 WESTFIELD ST
Second Line :
City : GRAVETTE
State : AR
Zip : 72736-9371
Country : US
Telephone Number : 316-249-1625
Fax Number :
Provider Business Practice Location Address
First Line : 3215 N NORTHHILLS BLVD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4424
Country : US
Telephone Number : 479-463-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2026
Last Update Date : 04/14/2026

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Directions to “ BRANDELEIN MARIE STEFONEK ” Practice Location

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