Basic Information
Provider Information | |||||||||
NPI: | 1649361825 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEY | ||||||||
FirstName: | STEPHANIE | ||||||||
MiddleName: | RENEE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PAC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PURNELL | ||||||||
OtherFirstName: | STEPHANIE | ||||||||
OtherMiddleName: | RENEE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PAC | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1296 BETHEL CHURCH RD | ||||||||
Address2: |   | ||||||||
City: | MIDDLETOWN | ||||||||
State: | DE | ||||||||
PostalCode: | 197099212 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3024492062 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4745 OGLETOWN STANTON RD | ||||||||
Address2: | SUITE 134 MEDICAL ARTS PAVILLION 1 | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197132067 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3027385300 | ||||||||
FaxNumber: | 3027314822 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/27/2006 | ||||||||
LastUpdateDate: | 04/28/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C50000470 | DE | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363A00000X | MA051892 | PA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
No ID Information.