MEDICARE: STEPHANIE DALE STORY N.D.

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	175F00000X	Naturopath

General Provider Information

NPI Number	:	1912089087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DALE STORY N.D.

Provider Business Mailing Address
First Line	:	1047 ANGLER LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6513
Country	:	US
Telephone Number	:	757-428-7979
Fax Number	:	757-747-0485

Provider Business Practice Location Address
First Line	:	1047 ANGLER LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6513
Country	:	US
Telephone Number	:	757-428-7979
Fax Number	:	757-747-0485

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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