Provider Demographics
NPI:1912089087
Name:STORY, STEPHANIE DALE (ND)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DALE
Last Name:STORY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 ANGLER LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6513
Mailing Address - Country:US
Mailing Address - Phone:757-428-7979
Mailing Address - Fax:757-747-0485
Practice Address - Street 1:1047 ANGLER LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6513
Practice Address - Country:US
Practice Address - Phone:757-428-7979
Practice Address - Fax:757-747-0485
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath