Provider Demographics
NPI:1548608144
Name:SARGENT, STEPHANIE KAYE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAYE
Last Name:SARGENT
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 1:26648 610TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55918-8034
Mailing Address - Country:US
Mailing Address - Phone:507-567-2924
Mailing Address - Fax:
Practice Address - Street 1:26648 610TH AVE
Practice Address - Street 2:
Practice Address - City:BROWNSDALE
Practice Address - State:MN
Practice Address - Zip Code:55918-8034
Practice Address - Country:US
Practice Address - Phone:507-567-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist