Provider Demographics
NPI:1780944280
Name:BEHNAM, STEPHANIE ERIN (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERIN
Last Name:BEHNAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ERIN
Other - Last Name:LINDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:965 E YOSEMITE AVE
Practice Address - Street 2:STE #2
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5938
Practice Address - Country:US
Practice Address - Phone:209-239-2528
Practice Address - Fax:209-239-8217
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21669363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health