Provider Demographics
NPI:1497305890
Name:CAIN, STEPHANIE DESHAWN
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DESHAWN
Last Name:CAIN
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 1:1250 COLTS PRIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312
Mailing Address - Country:US
Mailing Address - Phone:910-797-7011
Mailing Address - Fax:
Practice Address - Street 1:1250 COLTS PRIDE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312
Practice Address - Country:US
Practice Address - Phone:910-797-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider