Provider Demographics
NPI:1891764684
Name:MINIX, STEPHANIE LEE (NAVY IDC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LEE
Last Name:MINIX
Suffix:
Gender:F
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NBHC BAHRAIN
Mailing Address - Street 2:PSC 451 BOX 340
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09834-2800
Mailing Address - Country:BH
Mailing Address - Phone:09731-785-4325
Mailing Address - Fax:
Practice Address - Street 1:NBHC BAHRAIN
Practice Address - Street 2:PSC 451 BOX 340
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09834-2800
Practice Address - Country:BH
Practice Address - Phone:09731-785-4325
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman