Provider Demographics
NPI:1316793920
Name:TSEN, STEPHANIE R (LAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:TSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N CHERRY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6429
Mailing Address - Country:US
Mailing Address - Phone:480-331-1239
Mailing Address - Fax:
Practice Address - Street 1:321 N CHERRY
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6429
Practice Address - Country:US
Practice Address - Phone:480-331-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-012213171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist