Provider Demographics
NPI:1578817359
Name:BEYNON, STEPHANIE N (NMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:N
Last Name:BEYNON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N HUMPHREYS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3070
Mailing Address - Country:US
Mailing Address - Phone:928-637-6795
Mailing Address - Fax:928-637-6796
Practice Address - Street 1:624 N HUMPHREYS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3070
Practice Address - Country:US
Practice Address - Phone:928-637-6795
Practice Address - Fax:928-637-6796
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12-1343175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath