Provider Demographics
NPI:1073989208
Name:STG INTERNATIONAL
Entity Type:Organization
Organization Name:STG INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUDULIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:661-729-8655
Mailing Address - Street 1:340 E AVENUE I
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1900
Mailing Address - Country:US
Mailing Address - Phone:661-729-8655
Mailing Address - Fax:661-729-8656
Practice Address - Street 1:340 E AVENUE I
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1900
Practice Address - Country:US
Practice Address - Phone:661-729-8655
Practice Address - Fax:661-729-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty