Provider Demographics
NPI:1205209970
Name:HALL, STEFANIE J
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:JEAN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1616 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2834
Mailing Address - Country:US
Mailing Address - Phone:907-278-0308
Mailing Address - Fax:907-278-0408
Practice Address - Street 1:1616 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2834
Practice Address - Country:US
Practice Address - Phone:907-278-0308
Practice Address - Fax:907-278-0408
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1027725374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide