Provider Demographics
NPI:1295190437
Name:WILLETT, STEPHANIE NICOLE
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-9543
Mailing Address - Country:US
Mailing Address - Phone:559-300-3115
Mailing Address - Fax:
Practice Address - Street 1:2603 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-9543
Practice Address - Country:US
Practice Address - Phone:559-300-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023499163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse