Provider Demographics
NPI:1285023200
Name:SCHICK, STEPHANIE (MPAS PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SCHICK
Suffix:
Gender:F
Credentials:MPAS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 E YOSEMITE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8403
Mailing Address - Country:US
Mailing Address - Phone:209-383-4200
Mailing Address - Fax:209-388-0629
Practice Address - Street 1:65 N MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:209-201-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9253717-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant