Provider Demographics
NPI:1962676791
Name:MOCK, STEPHANIE CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:MOCK
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 1:8501 TANNER WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-8322
Mailing Address - Country:US
Mailing Address - Phone:251-441-6416
Mailing Address - Fax:251-441-6415
Practice Address - Street 1:8501 TANNER WMS RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-8322
Practice Address - Country:US
Practice Address - Phone:251-441-6416
Practice Address - Fax:251-441-6926
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians