Provider Demographics
NPI:1831663327
Name:DALTON, STEPHANIE NICOLE (CSA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:DALTON
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2435
Mailing Address - Country:US
Mailing Address - Phone:859-707-1104
Mailing Address - Fax:
Practice Address - Street 1:3480 YORKSHIRE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1886
Practice Address - Country:US
Practice Address - Phone:859-707-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4503246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant