Provider Demographics
NPI:1063121960
Name:CLUNE, STEPHANIE DIANA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DIANA
Last Name:CLUNE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DIANA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 CHAPEL VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4676
Mailing Address - Country:US
Mailing Address - Phone:347-748-8523
Mailing Address - Fax:
Practice Address - Street 1:2400 PRATT ST STE 5000
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3976
Practice Address - Country:US
Practice Address - Phone:919-684-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017216363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care