Provider Demographics
NPI:1942523113
Name:ST. HAILAIRE, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ST. HAILAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 E 58TH ST
Mailing Address - Street 2:APT.2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4120
Mailing Address - Country:US
Mailing Address - Phone:347-898-4420
Mailing Address - Fax:
Practice Address - Street 1:1354 E 58TH ST
Practice Address - Street 2:APT.2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4120
Practice Address - Country:US
Practice Address - Phone:347-898-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620734-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse