Provider Demographics
NPI:1356698872
Name:RODRIGUEZ, STEPHANIE ANNE (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 HOBART AVE
Mailing Address - Street 2:APT #3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4085
Mailing Address - Country:US
Mailing Address - Phone:347-216-4714
Mailing Address - Fax:
Practice Address - Street 1:1987 HOBART AVE
Practice Address - Street 2:APT #3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4085
Practice Address - Country:US
Practice Address - Phone:347-216-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse