Provider Demographics
NPI:1689806663
Name:HOPE, STEPHANIE LYSSA (CST)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYSSA
Last Name:HOPE
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ALYSSA
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:8950 W EMERALD ST STE 168
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8296
Mailing Address - Country:US
Mailing Address - Phone:208-321-1209
Mailing Address - Fax:208-321-1211
Practice Address - Street 1:1075 N CURTIS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1300
Practice Address - Country:US
Practice Address - Phone:208-323-2600
Practice Address - Fax:208-323-9172
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
ID109240246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist