Provider Demographics
NPI:1801217955
Name:BALLIET, STEPHANIE SEBILLE (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SEBILLE
Last Name:BALLIET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:COLLEEN
Other - Last Name:SEBILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:550 N 3RD STREET
Mailing Address - Street 2:HEALTH NORTH BUILDING, 3RD FLOOR
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 N 3RD STREET
Practice Address - Street 2:HEALTH NORTH BUILDING, 3RD FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-496-0907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OR201392304RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program