Provider Demographics
NPI:1922717586
Name:FUALAU, STEPHANIE NAI (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NAI
Last Name:FUALAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 BREAKER WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4265
Mailing Address - Country:US
Mailing Address - Phone:209-298-6650
Mailing Address - Fax:
Practice Address - Street 1:2828 BREAKER WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4265
Practice Address - Country:US
Practice Address - Phone:209-298-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95050743163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management