Provider Demographics
NPI:1104379916
Name:STIEBER, JENNIFER PAULINE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAULINE
Last Name:STIEBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E 19TH ST
Mailing Address - Street 2:LASERAWAY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1313
Mailing Address - Country:US
Mailing Address - Phone:540-421-7960
Mailing Address - Fax:
Practice Address - Street 1:35 E 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1313
Practice Address - Country:US
Practice Address - Phone:540-421-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner