Provider Demographics
NPI:1669932265
Name:TABER, STEPHANIE E (FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:TABER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 GRANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4580
Mailing Address - Country:US
Mailing Address - Phone:614-571-6181
Mailing Address - Fax:703-656-4940
Practice Address - Street 1:2296 OPITZ BLVD STE 440
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3355
Practice Address - Country:US
Practice Address - Phone:703-878-0740
Practice Address - Fax:703-656-4940
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPENDING207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology