Provider Demographics
NPI:1538836507
Name:BLACK, STEPHANIE E (MSN, LNP, NP-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:E
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSN, LNP, NP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:E
Other - Last Name:DESHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, LNP, NP-C
Mailing Address - Street 1:6161 KEMPSVILLE CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3932
Mailing Address - Country:US
Mailing Address - Phone:757-261-5712
Mailing Address - Fax:
Practice Address - Street 1:6161 KEMPSVILLE CIR STE 240
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3932
Practice Address - Country:US
Practice Address - Phone:757-261-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily