Provider Demographics
NPI:1376897546
Name:DANG, STEPHANIE LAN (ACNS-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAN
Last Name:DANG
Suffix:
Gender:F
Credentials:ACNS-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7337 MENCHACA RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5336
Mailing Address - Country:US
Mailing Address - Phone:210-367-9953
Mailing Address - Fax:
Practice Address - Street 1:1013 W 9TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4923
Practice Address - Country:US
Practice Address - Phone:512-937-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX791452364SA2200X
TXAP122750363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health