Provider Demographics
NPI:1124048400
Name:HORN, STEPHANIE ANN (MS RD LDN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:HORN
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:VIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1307 PARADISE FALLS
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326
Mailing Address - Country:US
Mailing Address - Phone:570-620-0140
Mailing Address - Fax:
Practice Address - Street 1:500 PLAZA COURT SUITE B
Practice Address - Street 2:POCONO INTERNAL MEDICINE
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-421-8526
Practice Address - Fax:570-421-7899
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001129133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered