Provider Demographics
NPI:1275636235
Name:STEBBING, JENNIFER KATSU (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATSU
Last Name:STEBBING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NH
Mailing Address - Zip Code:03870-2055
Mailing Address - Country:US
Mailing Address - Phone:215-630-5935
Mailing Address - Fax:
Practice Address - Street 1:1 GREENLEAF WOODS DR UNIT 102
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5437
Practice Address - Country:US
Practice Address - Phone:603-436-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11642207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH11642OtherLICENSE
G81699Medicare UPIN
RE6672Medicare ID - Type Unspecified