Provider Demographics
NPI:1881984292
Name:CORREA, STEPHANIE (CERTPHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:CERTPHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8134
Mailing Address - Country:US
Mailing Address - Phone:214-394-5511
Mailing Address - Fax:214-502-4210
Practice Address - Street 1:3301 FRANCIS DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8134
Practice Address - Country:US
Practice Address - Phone:214-394-5511
Practice Address - Fax:214-502-4210
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644909171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor