Provider Demographics
NPI:1609506567
Name:LINK, STEPHANIE JOY
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOY
Last Name:LINK
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 1:4408 PEACH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1374
Mailing Address - Country:US
Mailing Address - Phone:814-866-3458
Mailing Address - Fax:
Practice Address - Street 1:865 CHERRY ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-7803
Practice Address - Country:US
Practice Address - Phone:814-796-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN549496163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice