Provider Demographics
NPI:1508277393
Name:RHODES, STEPHANIE WELLS
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WELLS
Last Name:RHODES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:L
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-0074
Mailing Address - Country:US
Mailing Address - Phone:434-295-6565
Mailing Address - Fax:
Practice Address - Street 1:1218 HARRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5340
Practice Address - Country:US
Practice Address - Phone:434-295-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA910000269171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor