Stephanie G Mishenko
Military Health Care Provider in Slc, UT. Individual provider (NPI-1).
NPI number1790396554
StatusActive
Last updated in NPPESAug 13, 2020
Details
- NPI
- 1790396554
- Entity type
- Individual (NPI-1)
- Name
- Stephanie G Mishenko
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 13, 2020
- Certification date
- Aug 13, 2020
- Last updated
- Aug 13, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171000000X | Military Health Care Provider | – | UT | Yes |
Practice location
344e 100sSlc, UT 84111
Phone 801-322-3222
Mailing address
344e 100sSlc, UT 84111
Phone 801-322-3222
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