Provider Demographics
NPI:1730748963
Name:HARRISON, STEPHANIE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:WALL
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:38 W MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2814
Mailing Address - Country:US
Mailing Address - Phone:801-703-3846
Mailing Address - Fax:
Practice Address - Street 1:38 W MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2814
Practice Address - Country:US
Practice Address - Phone:801-703-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6543804-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily