STEPHANIE VAN DINE (NPI# 1588153498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588153498 |
| Entity Type | Individual |
| Full Name | STEPHANIE VAN DINE |
| Practice Address |
6070 Lakeside Commons Dr Macon GA 31210-5778 |
| Mailing Address |
406 High Point Rd Nw Milledgeville GA 31061-7068 |
| Practice Telephone | 4782542644 |
| Mailing Telephone | 2563109987 |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-05-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN275921 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6070 LAKESIDE COMMONS DR |
| City | MACON |
| State | GA |
| Zip Code | 31210-5778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548265549 | Rallie D Cogburn Sr. | Physician Assistant | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2005-06-16 |
| 1194350546 | Serwah Sarponma Amponsah | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2020-03-05 |
| 1336791292 | Morgan Dowd | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2019-07-11 |
| 1740849082 | Heather Hall | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2019-06-11 |
| 1598028060 | Susannah Burns Goodman | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2012-06-20 |
| 1205113057 | Middle Georgia Heart and Vascular Center, LLC | Internal Medicine | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2011-11-08 |
| 1376873513 | Angela Rhea Ballard | Physician Assistant | 6070 Lakeside Commons Dr, Macon, GA 31210 | 2010-01-11 |
| 1962650440 | Olexandr V. Smolensky | Internal Medicine | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2008-09-08 |
| 1922007541 | William Douglas Knopf | Internal Medicine | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2005-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1871124735 | Jessica Bello | Nurse Practitioner | 5300 Bowman Road, Macon, GA 31210 | 2020-01-30 |
| 1225505787 | Rebekah Hollinshead | Occupational Therapist | Therapy Specialists of Georgia, 4116 Arkwright Road, Macon, GA 31210 | 2018-11-01 |
| 1346744943 | Ace Medical Transport LLC. | Ambulance | 728 Gay Dr, Macon, GA 31210 | 2018-03-20 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1992176952 | Kerisia Wasztyl | Marriage & Family Therapist | 4691 Pine Valley Dr, Macon, GA 31210 | 2015-10-15 |
| 1073905444 | Eunice Malave De Leon | Social Worker | 174 Spring St, Macon, GA 31210 | 2015-02-23 |
| 1396141545 | Axis Surgery Center LLC | Clinic/Center | 230 Sheraton Blvd, Ste B, Macon, GA 31210 | 2014-11-17 |
| 1073914115 | Monique Rechelle Delay Moore | Community/Behavioral Health | 646 Millrun Court, Macon, GA 31210 | 2014-09-09 |
| Find all providers in zip 31210 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093315848 | Tracy Tarvers | Nurse Practitioner | 129 Wolf Creek Dr N, Macon, GA 31210-9002 | 2020-10-30 |
| 1578160560 | Ida Mayaka | Nurse Practitioner | 210 Autumn Trace Ct, Macon, GA 31210-8025 | 2020-10-03 |
| 1427664465 | Shanna Lynn Beaulieu | Nurse Practitioner | 781 Spring St Ste 230, Macon, GA 31201-2185 | 2020-09-16 |
| 1467070557 | Raquel Simmons | Nurse Practitioner | 670 Ivy Brook Way, Macon, GA 31210-5520 | 2020-07-06 |
| 1174159800 | Jamie K Polk | Nurse Practitioner | 3951 Ridge Ave Ste C, Macon, GA 31210-5064 | 2020-03-13 |
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1730730581 | Lindsay Fernandez | Nurse Practitioner | 102 Saint Johns Pl, Macon, GA 31210-8606 | 2019-09-24 |
| 1003468240 | Skylar Nelson | Nurse Practitioner | 330 Hospital Dr Ste 200, Macon, GA 31217-8034 | 2019-07-09 |
| 1861051880 | Courtney Elizabeth Avery | Nurse Practitioner | 540 Charter Blvd Ste 400, Macon, GA 31210-4882 | 2019-06-12 |
| 1376101196 | Detra K Dixon | Nurse Practitioner | 227 Amalie Dr, Macon, GA 31220-2667 | 2019-06-05 |
| Find all providers in MACON | ||||
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| 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.