Provider Demographics
NPI:1861673782
Name:NIEDERMAN, STEPANIE ANN (LAC, DIPL OF ACUP)
Entity Type:Individual
Prefix:MRS
First Name:STEPANIE
Middle Name:ANN
Last Name:NIEDERMAN
Suffix:
Gender:F
Credentials:LAC, DIPL OF ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16233
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96151-6233
Mailing Address - Country:US
Mailing Address - Phone:530-542-0614
Mailing Address - Fax:
Practice Address - Street 1:1669 PLATEAU CIR
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7432
Practice Address - Country:US
Practice Address - Phone:530-542-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 2703171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist