Provider Demographics
NPI:1972193464
Name:BURHOP, STEPHANIE JOANNE (MS, RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOANNE
Last Name:BURHOP
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 E DALEY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-2469
Mailing Address - Country:US
Mailing Address - Phone:480-532-0192
Mailing Address - Fax:
Practice Address - Street 1:1908 E DALEY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-2469
Practice Address - Country:US
Practice Address - Phone:480-532-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86176362133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered