Provider Demographics
NPI:1225616758
Name:RODRIGUEZ, STEPHANIE NICOLE (CNIM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:NICOLE
Other - Last Name:LIEBENTRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNIM
Mailing Address - Street 1:1301 WILDERNESS ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-5137
Mailing Address - Country:US
Mailing Address - Phone:815-970-3499
Mailing Address - Fax:
Practice Address - Street 1:3400 WATERVIEW PKWY STE 305
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1566
Practice Address - Country:US
Practice Address - Phone:214-551-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic