Provider Demographics
NPI:1487167995
Name:TAIJERON, STEPHANIE (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TAIJERON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 UOG STA
Mailing Address - Street 2:
Mailing Address - City:MANGILAO
Mailing Address - State:GU
Mailing Address - Zip Code:96923
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 HARMON LUKE ROAD, SUITE 300
Practice Address - Street 2:
Practice Address - City:BEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-647-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNP0172363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care