Provider Demographics
NPI:1891438453
Name:THEVENOT, STEPHANIA (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:THEVENOT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PAERDEGAT 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4869
Mailing Address - Country:US
Mailing Address - Phone:929-535-1875
Mailing Address - Fax:
Practice Address - Street 1:2 PAERDEGAT 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4869
Practice Address - Country:US
Practice Address - Phone:929-535-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334614-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse