Provider Demographics
NPI:1285986745
Name:SCHOUTEN, STEPHANIE HANNON (N P)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HANNON
Last Name:SCHOUTEN
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 BRIDGETON PARK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4153
Mailing Address - Country:US
Mailing Address - Phone:901-634-5139
Mailing Address - Fax:
Practice Address - Street 1:170 MANNING DR OFC BUILDING
Practice Address - Street 2:CB# 7236
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4221
Practice Address - Country:US
Practice Address - Phone:919-966-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227870363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics