Provider Demographics
NPI:1508069162
Name:STEPHENSON, JEANNE RENEE
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:RENEE
Last Name:STEPHENSON
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 1:1013 W GOLD AVE
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1788
Mailing Address - Country:US
Mailing Address - Phone:432-599-9641
Mailing Address - Fax:
Practice Address - Street 1:1013 W GOLD AVE
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1788
Practice Address - Country:US
Practice Address - Phone:432-599-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography