Provider Demographics
NPI:1235725615
Name:RODENBERRY, STEPHANIE GWEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GWEN
Last Name:RODENBERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 S MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2122
Mailing Address - Country:US
Mailing Address - Phone:256-650-4665
Mailing Address - Fax:256-650-4665
Practice Address - Street 1:11100 S MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2122
Practice Address - Country:US
Practice Address - Phone:256-650-4665
Practice Address - Fax:256-650-4624
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily