Provider Demographics
NPI:1720663560
Name:FLEMING, STEPHANIE JO (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:FLEMING
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 1:110 ESPLANADE AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1377
Mailing Address - Country:US
Mailing Address - Phone:915-727-1603
Mailing Address - Fax:
Practice Address - Street 1:1871 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3220
Practice Address - Country:US
Practice Address - Phone:650-692-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95238977163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice