Basic Information
| Provider Information | |||||||||
| NPI: | 1932209152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STIEBEN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675014406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206696690 | ||||||||
| FaxNumber: | 6206944528 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675014405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206696690 | ||||||||
| FaxNumber: | 6206944528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 15-00986 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 200271320A | 05 | KS | MEDICAID |