Provider Demographics
NPI:1558710244
Name:STILLWELL, STEPHANIE RAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RAE
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E BUNNELL AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7844
Mailing Address - Country:US
Mailing Address - Phone:907-235-8857
Mailing Address - Fax:907-235-7090
Practice Address - Street 1:195 E BUNNELL AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7844
Practice Address - Country:US
Practice Address - Phone:907-235-8857
Practice Address - Fax:907-235-7090
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104054163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse