Provider Demographics
NPI:1407009673
Name:CONNOR, STEPHANIE GWENETTE (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GWENETTE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SIGNAL HILL DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625
Mailing Address - Country:US
Mailing Address - Phone:704-883-8637
Mailing Address - Fax:704-883-8638
Practice Address - Street 1:524 SIGNAL HILL DRIVE EXT
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4391
Practice Address - Country:US
Practice Address - Phone:704-883-8637
Practice Address - Fax:704-883-8638
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28021164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse