Provider Demographics
NPI:1477802627
Name:KELLY-STAHLNECKER, STEVEN ALAN (HM)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALAN
Last Name:KELLY-STAHLNECKER
Suffix:
Gender:M
Credentials:HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDING OFFICER 1ST BN 3D MARINES 3D MARINE REGIMENT
Mailing Address - Street 2:PO BOX 63006
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96863
Mailing Address - Country:US
Mailing Address - Phone:808-257-2281
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER 1ST BN 3D MARINES 3D MARINE REGIMENT
Practice Address - Street 2:MCBH REGIMENTAL AID STATION
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96863-3006
Practice Address - Country:US
Practice Address - Phone:808-257-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman