Provider Demographics
NPI:1114205499
Name:MASCORRO, STEPHANIE WHITENTON (APN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:WHITENTON
Last Name:MASCORRO
Suffix:
Gender:F
Credentials:APN
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Mailing Address - Street 1:13701 NORTHWEST BLVD
Mailing Address - Street 2:STE. B-1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5114
Mailing Address - Country:US
Mailing Address - Phone:361-767-0303
Mailing Address - Fax:361-767-1220
Practice Address - Street 1:13701 NORTHWEST BLVD
Practice Address - Street 2:STE. B-1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5114
Practice Address - Country:US
Practice Address - Phone:361-767-0303
Practice Address - Fax:361-767-1220
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX679431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily