Provider Demographics
NPI:1851375976
Name:ROPER, STEPHEN VAN (FNP-C, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:VAN
Last Name:ROPER
Suffix:
Gender:M
Credentials:FNP-C, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC09 5350
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2375
Mailing Address - Fax:505-272-8901
Practice Address - Street 1:MSC09 5350
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2375
Practice Address - Fax:505-272-8901
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099007691N1363LF0000X
NMCNP-02104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110818Medicaid
ORR162941Medicare PIN
ORR152705Medicare PIN
AZP41646Medicare UPIN