Provider Demographics
NPI:1912026345
Name:STEFANO, LINDA DARLENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:DARLENE
Last Name:STEFANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KEY LARGO CT
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1244
Mailing Address - Country:US
Mailing Address - Phone:636-296-2634
Mailing Address - Fax:
Practice Address - Street 1:12345 W BEND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2104
Practice Address - Country:US
Practice Address - Phone:314-843-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO098431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO098431OtherNURSE PRCTITIONER LICENSE