Provider Demographics
NPI:1841298627
Name:STEPHENS, YVONNE MARIE (RD CDE)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 N H ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3301
Mailing Address - Country:US
Mailing Address - Phone:805-737-8753
Mailing Address - Fax:805-737-8761
Practice Address - Street 1:1225 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3301
Practice Address - Country:US
Practice Address - Phone:805-737-8753
Practice Address - Fax:805-737-8761
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WNT 313351CMedicare ID - Type Unspecified