Provider Demographics
NPI:1629647581
Name:KYLE, STEPHANIE ROSEANNE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ROSEANNE
Last Name:KYLE
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 1:1052 48TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3911
Mailing Address - Country:US
Mailing Address - Phone:240-274-1694
Mailing Address - Fax:
Practice Address - Street 1:1052 48TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3911
Practice Address - Country:US
Practice Address - Phone:240-274-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant