Provider Demographics
NPI:1154775229
Name:PAINTER, STEFANIE LYNN (DHED, RD, LD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:LYNN
Last Name:PAINTER
Suffix:
Gender:F
Credentials:DHED, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-1080
Mailing Address - Country:US
Mailing Address - Phone:304-546-9968
Mailing Address - Fax:
Practice Address - Street 1:703 EMERALD DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-1080
Practice Address - Country:US
Practice Address - Phone:304-546-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV774133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered