Provider Demographics
NPI:1699591164
Name:PENA, STEFANIE L (RN)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:PENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8088 HIGHWAY 359
Mailing Address - Street 2:
Mailing Address - City:MATHIS
Mailing Address - State:TX
Mailing Address - Zip Code:78368-4102
Mailing Address - Country:US
Mailing Address - Phone:361-255-9701
Mailing Address - Fax:
Practice Address - Street 1:205 S ENTERPRIZE PKWY
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-4118
Practice Address - Country:US
Practice Address - Phone:361-939-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX810841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse