Provider Demographics
NPI:1336963057
Name:STEPHANOFF, LAUREN NAZARI (RNO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NAZARI
Last Name:STEPHANOFF
Suffix:
Gender:F
Credentials:RNO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 LOTUS WAY
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3638
Mailing Address - Country:US
Mailing Address - Phone:310-529-0445
Mailing Address - Fax:
Practice Address - Street 1:1171 7TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2714
Practice Address - Country:US
Practice Address - Phone:831-476-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685024163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse