Provider Demographics
NPI:1093523441
Name:BOHN, STEPHANIE (STUDENT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BOHN
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:BOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STUDENT
Mailing Address - Street 1:278 WHITES BRIDGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-5263
Mailing Address - Country:US
Mailing Address - Phone:207-839-7957
Mailing Address - Fax:
Practice Address - Street 1:278 WHITES BRIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-5263
Practice Address - Country:US
Practice Address - Phone:207-839-7957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program