Provider Demographics
NPI:1336237015
Name:NANSON, STEPHANIE J (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:J
Last Name:NANSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N EUCLID ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1623
Mailing Address - Country:US
Mailing Address - Phone:714-888-6860
Mailing Address - Fax:714-888-6867
Practice Address - Street 1:300 N EUCLID ST
Practice Address - Street 2:SUITE A
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1623
Practice Address - Country:US
Practice Address - Phone:714-888-6860
Practice Address - Fax:714-888-6867
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4870213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100164800AMedicaid
IN000000184576OtherANTHEM BCBS
IN480008699OtherRAILROAD MEDICARE
IN4128970001OtherMEDICARE DME
INT93251Medicare UPIN
IN100164800AMedicaid