Provider Demographics
NPI:1316677586
Name:TAYLOR, STEPHANIE JUNEAU
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUNEAU
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEIGH
Other - Last Name:JUNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1334 W PIERCE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4053
Mailing Address - Country:US
Mailing Address - Phone:318-542-1633
Mailing Address - Fax:
Practice Address - Street 1:9525 KATY FWY STE 206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1476
Practice Address - Country:US
Practice Address - Phone:713-863-7246
Practice Address - Fax:713-863-9524
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084105367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered