Provider Demographics
NPI:1154892453
Name:THIRIOT, STEPHANIE NICHOLE (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICHOLE
Last Name:THIRIOT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W CENTRAL AVE STE G
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2830
Mailing Address - Country:US
Mailing Address - Phone:805-735-4292
Mailing Address - Fax:805-735-4293
Practice Address - Street 1:217 W CENTRAL AVE STE G
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2830
Practice Address - Country:US
Practice Address - Phone:805-735-4292
Practice Address - Fax:805-735-4293
Is Sole Proprietor?:No
Enumeration Date:2018-12-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA56472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant