Provider Demographics
NPI:1376523258
Name:MASTNY, STEPHANIE RAE (APRN C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RAE
Last Name:MASTNY
Suffix:
Gender:F
Credentials:APRN C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N HOWARD AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3529
Mailing Address - Country:US
Mailing Address - Phone:308-380-3498
Mailing Address - Fax:
Practice Address - Street 1:908 N HOWARD AVE
Practice Address - Street 2:STE 109
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3529
Practice Address - Country:US
Practice Address - Phone:308-380-3498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49832163W00000X
NE110402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
274041WIMedicare ID - Type Unspecified
P28611Medicare UPIN