Provider Demographics
NPI:1487260832
Name:EAST, STEPHANIE MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:EAST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 WIGGINGTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5155
Mailing Address - Country:US
Mailing Address - Phone:434-686-7418
Mailing Address - Fax:866-308-9365
Practice Address - Street 1:808 WIGGINGTON RD STE D
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5155
Practice Address - Country:US
Practice Address - Phone:434-686-7418
Practice Address - Fax:866-308-9365
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181136363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health