Provider Demographics
NPI:1073290433
Name:NEKOROSKI, STEPHANIE ARRIA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ARRIA
Last Name:NEKOROSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 OCTAVIA ST APT 528
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5891
Mailing Address - Country:US
Mailing Address - Phone:978-806-6970
Mailing Address - Fax:
Practice Address - Street 1:2 H ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1700
Practice Address - Country:US
Practice Address - Phone:415-459-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024482363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health