Provider Demographics
NPI:1164869517
Name:HASKETT-CARRASCO, STEPHANIE LYNNE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:HASKETT-CARRASCO
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 1:1700 SYCAMORE AVE
Mailing Address - Street 2:#A
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-2740
Mailing Address - Country:US
Mailing Address - Phone:909-282-0307
Mailing Address - Fax:
Practice Address - Street 1:1700 SYCAMORE AVE
Practice Address - Street 2:#A
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-2740
Practice Address - Country:US
Practice Address - Phone:909-282-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner