Provider Demographics
NPI:1700035193
Name:PROIA, STEFANIE A (CPNP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:A
Last Name:PROIA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18546 ROSCOE BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4663
Mailing Address - Country:US
Mailing Address - Phone:818-885-8040
Mailing Address - Fax:818-267-5633
Practice Address - Street 1:18546 ROSCOE BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4663
Practice Address - Country:US
Practice Address - Phone:818-885-8040
Practice Address - Fax:818-267-5633
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18431363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics