Stephanie G Mishenko

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

Practice address

344E 100S
SLC, UT 84111

Phone

(801) 322-3222

NPI assigned

Aug 13, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1790396554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344E 100S",
            "city": "SLC",
            "state": "UT",
            "postal_code": "84111",
            "telephone_number": "801-322-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344E 100S",
            "city": "SLC",
            "state": "UT",
            "postal_code": "84111",
            "telephone_number": "801-322-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHENKO",
        "first_name": "STEPHANIE",
        "middle_name": "G",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Military Health Care Provider",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17100000X",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Military Health Care Provider in SLC, UT
• Providers in SLC, UT by specialty
• Military Health Care Provider in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.