Provider Demographics
NPI:1881857480
Name:PENICK, STEPHANIE C (MIDWIFE)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:C
Last Name:PENICK
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:C
Other - Last Name:SEPULVEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM
Mailing Address - Street 1:5824 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85219
Mailing Address - Country:US
Mailing Address - Phone:480-982-0718
Mailing Address - Fax:480-982-0718
Practice Address - Street 1:5824 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-9318
Practice Address - Country:US
Practice Address - Phone:480-982-0718
Practice Address - Fax:480-982-0718
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife