Provider Demographics
NPI:1255769261
Name:CATUOGNO, STEPHANIE BUI (MSPAS, PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BUI
Last Name:CATUOGNO
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:THUY VI
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPAS, PA-C
Mailing Address - Street 1:6609 SANGER AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4252
Mailing Address - Country:US
Mailing Address - Phone:254-399-6941
Mailing Address - Fax:254-399-6567
Practice Address - Street 1:6609 SANGER AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4252
Practice Address - Country:US
Practice Address - Phone:254-399-6941
Practice Address - Fax:254-399-6567
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017033363A00000X
PAMA056533363A00000X
TXPA08808363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical