STEPHANIE LYNN FANOUS (NPI# 1306344122) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306344122 |
| Entity Type | Individual |
| Full Name | STEPHANIE LYNN FANOUS |
| Credential | NP |
| Practice Address |
2175 Park Pl El Segundo CA 90245-4705 |
| Mailing Address |
1286 Bonnie Brae St Hermosa Beach CA 90254-4028 |
| Practice Telephone | 3103544318 |
| Mailing Telephone | 3109635719 |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2018-01-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95008438 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2175 PARK PL |
| City | EL SEGUNDO |
| State | CA |
| Zip Code | 90245-4705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285884098 | Anish Thomas Peter | Internal Medicine | 2175 Park Pl, El Segundo, CA 90245-4705 | 2008-09-29 |
| 1083103956 | Jeffensen Jay Timacdog | Nurse Practitioner | 2175 Park Pl, El Segundo, CA 90245-4705 | 2018-05-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366058976 | Britt'nee Cornelius | Massage Therapist | 222 North PCh, Suite 2000, El Segundo, CA 90245 | 2020-09-18 |
| 1750913778 | Laurie Ann Scoppetto | Dietitian, Registered | 482 N Aviation Blvd, El Segundo, CA 90245 | 2020-02-07 |
| 1972135283 | A Dabrowska Dds, Inc | Dentist | 390 N. Pacific Coast Hwy #1050, El Segundo, CA 90245 | 2020-02-05 |
| 1578023057 | Miles Bertumen | Pharmacist | 283 N Aviation Blvd, Building 210, El Segundo, CA 90245 | 2019-03-21 |
| 1831673201 | Kriss L. Killam | Marriage & Family Therapist | 302 W. Grand Ave., Suite 9, El Segundo, CA 90245 | 2018-09-20 |
| 1811487911 | Bright Light Recovery | Substance Abuse Rehabilitation Facility | 218 Concord St, Suite C, El Segundo, CA 90245 | 2018-05-14 |
| 1265950448 | Sarah Yuriko Mizuki | Physician Assistant | 390 N PCh, Suite 1000, El Segundo, CA 90245 | 2017-09-07 |
| 1326586462 | Jlp Interpreting Services | Interpreter | 963 Virginia St #5, El Segundo, CA 90245 | 2017-02-09 |
| 1619351707 | El Segundo Dermatology, Inc. | Specialist | 713 N Douglas St., El Segundo, CA 90245 | 2015-07-17 |
| 1083956635 | 24hr Homecare, LLC | Home Health | 200 N. Pacific Coast Highway, Suite 300, El Segundo, CA 90245 | 2013-03-21 |
| Find all providers in zip 90245 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164822789 | Amanda Rhoads | Nurse Practitioner | 740 S Allied Way, El Segundo, CA 90245-5514 | 2014-09-02 |
| 1548448236 | Tam B. Tran | Nurse Practitioner | 225 W Sycamore Ave, El Segundo, CA 90245-2218 | 2008-02-05 |
| 1669014866 | Channe Bunthung | Nurse Practitioner | 390 N Pacific Coast Hwy, El Segundo, CA 90245-4475 | 2019-10-09 |
| 1154981355 | Viviane Sanada | Nurse Practitioner | 2101 Rosecrans Ave Ste 3230, El Segundo, CA 90245-4749 | 2019-06-19 |
| 1811552805 | Jennifer Ko | Nurse Practitioner | 898 N Pacific Coast Hwy Ste 600, El Segundo, CA 90245-2747 | 2019-05-05 |
| 1699246371 | Heather Garza | Nurse Practitioner | 2218 E Maple Ave, El Segundo, CA 90245-6507 | 2018-12-06 |
| 1720573439 | Marilyn Tadiaman Pudol | Nurse Practitioner | 2101 Rosecrans Ave # 3230, El Segundo, CA 90245-4749 | 2018-06-25 |
| 1366954620 | Basanta Kc | Nurse Practitioner | 2101 Rosecrans Ave # 3230, El Segundo, CA 90245-4749 | 2017-10-26 |
| 1003332909 | Kenn Rafanan | Nurse Practitioner | 2101 Rosecrans Ave # 3230, El Segundo, CA 90245-4749 | 2017-08-22 |
| 1871014043 | Andrea Gold | Nurse Practitioner | 222 N Sepulveda Blvd, El Segundo, CA 90245-5648 | 2017-06-28 |
| Find all providers in EL SEGUNDO | ||||
| City | EL SEGUNDO |
| Zip Code | 90245 |
Please comment or provide details below to improve the information on STEPHANIE LYNN FANOUS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.