Provider Demographics
NPI:1104222868
Name:SUBLETT, STEFANIE (PA-C)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SUBLETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 CALIFORNIA ST
Mailing Address - Street 2:STE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1953
Mailing Address - Country:US
Mailing Address - Phone:530-247-7070
Mailing Address - Fax:530-244-7246
Practice Address - Street 1:2656 EDITH AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3030
Practice Address - Country:US
Practice Address - Phone:530-244-2882
Practice Address - Fax:530-244-3703
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51976363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical