Stefanie Marie Gibbons, ASW
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Coarsegold, CA
NPI 1982205217 · NPPES record last updated Jul 22, 2023
Key facts
- NPI
- 1982205217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- 1982205217 (CA)
- Practice address
- 45340 Windmill Rd
Coarsegold, CA 93614-9345 - Phone
- (281) 468-1094
- NPI assigned
- Nov 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1982205217 | CA | MD | Student in an Organized Health Care Education/Training Program |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 1982205217 | CA | Yes |
Addresses
Primary practice location
45340 Windmill Rd
Coarsegold, CA 93614-9345
Mailing address
45340 Windmill Rd
Coarsegold, CA 93614-9345
Phone (281) 468-1094
Other names
- Stefanie Marie Wallace
Other providers in Coarsegold, CA
- Maria Denise Elliott
- Martha Grace Foster
- John Eric Francom
- Tracy Lee Frederick
- Darren Gibbons
- Rachel Marie Gren
- Sally Kathleen Pearson Kent
- Faynalda Joann King
- Kroeger Enterprises LLC
- Phillip Brandon Kroeger
All providers in Coarsegold, CA · Student in an Organized Health Care Education/Training Program in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.