Provider Demographics
NPI:1811089378
Name:WOELFLE, STEPHANIE J (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:WOELFLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8146 TOWNLEY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8080
Mailing Address - Country:US
Mailing Address - Phone:704-488-5811
Mailing Address - Fax:
Practice Address - Street 1:5407 SKY LANE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3953
Practice Address - Country:US
Practice Address - Phone:919-219-8546
Practice Address - Fax:919-687-7649
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRN157758163WP0809X
NC201074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00213558OtherRR MEDICARE # - PARADIGM
NC7000246Medicaid
NCP00213558OtherRR MEDICARE # - PARADIGM
NC7000246Medicaid