Provider Demographics
NPI:1790073351
Name:CROSS, STEPHANIE N (LMT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:N
Last Name:CROSS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:N
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:9995 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5341
Mailing Address - Country:US
Mailing Address - Phone:303-790-1710
Mailing Address - Fax:
Practice Address - Street 1:7572 S QUEMOY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-7136
Practice Address - Country:US
Practice Address - Phone:720-684-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6623171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor