Provider Demographics
NPI:1013054717
Name:DUARTE, STEPHANIE R (MSN,FNP,BC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:DUARTE
Suffix:
Gender:F
Credentials:MSN,FNP,BC
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:THURLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 N STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-1945
Mailing Address - Country:US
Mailing Address - Phone:816-540-2111
Mailing Address - Fax:816-540-6065
Practice Address - Street 1:1601 N STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-1945
Practice Address - Country:US
Practice Address - Phone:816-540-2111
Practice Address - Fax:816-540-6065
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
706F445OtherMEDICARE INDIVIDUAL
MO598296101Medicaid
706F445OtherMEDICARE INDIVIDUAL