Provider Demographics
NPI:1962730226
Name:JOYNER, STEPHANIE MICHELLE
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:JOYNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:MICHELLE
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3858 PULASKI AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-3540
Mailing Address - Country:US
Mailing Address - Phone:215-837-3304
Mailing Address - Fax:215-228-9194
Practice Address - Street 1:3858 PULASKI AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-3540
Practice Address - Country:US
Practice Address - Phone:215-837-3304
Practice Address - Fax:215-228-9194
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9609430246RP1900X, 374700000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No374700000XNursing Service Related ProvidersTechnician