Provider Demographics
NPI:1952752446
Name:WINDHAM, STEFFANY (APRN)
Entity Type:Individual
Prefix:
First Name:STEFFANY
Middle Name:
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STEFFANY
Other - Middle Name:JILL
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:2913 BETIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7257
Mailing Address - Country:US
Mailing Address - Phone:318-388-1250
Mailing Address - Fax:
Practice Address - Street 1:2913 BETIN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7257
Practice Address - Country:US
Practice Address - Phone:318-388-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-26
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN133704251J00000X
LAAP08951363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1044400713OtherNATIONAL CERTIFICATION CORPORATION