Provider Demographics
NPI:1861751158
Name:MUNRO, STEPHNIE V (NP)
Entity type:Individual
Prefix:
First Name:STEPHNIE
Middle Name:V
Last Name:MUNRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 MERRICK ROAD, SUITE 206
Mailing Address - Street 2:
Mailing Address - City:BALDWINE
Mailing Address - State:NY
Mailing Address - Zip Code:11413
Mailing Address - Country:US
Mailing Address - Phone:516-442-4787
Mailing Address - Fax:
Practice Address - Street 1:865 MERRICK RD STE 206
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3338
Practice Address - Country:US
Practice Address - Phone:516-442-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306031-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health