Provider Demographics
NPI:1811055528
Name:STEFFENSEN, LI W (PHD,LAC)
Entity type:Individual
Prefix:DR
First Name:LI
Middle Name:W
Last Name:STEFFENSEN
Suffix:
Gender:F
Credentials:PHD,LAC
Other - Prefix:DR
Other - First Name:LUCY
Other - Middle Name:W
Other - Last Name:STEFFENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD,LAC
Mailing Address - Street 1:9360 N NAME UNO STE 240
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3535
Mailing Address - Country:US
Mailing Address - Phone:408-846-8468
Mailing Address - Fax:408-778-1886
Practice Address - Street 1:9360 N NAME UNO STE 240
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3535
Practice Address - Country:US
Practice Address - Phone:408-846-8468
Practice Address - Fax:408-778-1886
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7985364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADR20-00658IOtherMEDICAL INSURANCE EXCHANG