Provider Demographics
NPI:1992513501
Name:PERALES, STEPHANIE EDIRIS
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EDIRIS
Last Name:PERALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-2113
Mailing Address - Country:US
Mailing Address - Phone:531-222-5937
Mailing Address - Fax:
Practice Address - Street 1:2204 ALBERT ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-2113
Practice Address - Country:US
Practice Address - Phone:531-222-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion