Provider Demographics
NPI:1942079165
Name:OTOO, STEPHANIE JOY (MSN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOY
Last Name:OTOO
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6660 GOLDENCREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-8400
Mailing Address - Country:US
Mailing Address - Phone:714-722-4959
Mailing Address - Fax:
Practice Address - Street 1:6660 GOLDENCREEK WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-8400
Practice Address - Country:US
Practice Address - Phone:714-722-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV819789363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health