Provider Demographics
NPI:1770053688
Name:STORY, STEPHANIE MARION (BSN, RN, PHN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARION
Last Name:STORY
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BATES AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1208
Mailing Address - Country:US
Mailing Address - Phone:925-608-5134
Mailing Address - Fax:925-608-5160
Practice Address - Street 1:2500 BATES AVE STE B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1208
Practice Address - Country:US
Practice Address - Phone:925-608-5134
Practice Address - Fax:925-608-5160
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032528163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD8528490OtherDRIVER'S LICENSE
CA95032528OtherBOARD OF REGISTERED NURSING