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Stephanie G Mishenko
Military Health Care Provider in Slc, Utah
NPI 1790396554

Stephanie G Mishenko is a Military Health Care Provider based in Slc, UT. Stephanie G Mishenko practices in Slc, UT. The NPI Number for Stephanie G Mishenko is 1790396554 and holds a License No. (Utah).

The current practice location address for Stephanie G Mishenko is 344E 100S, Slc, UT and can be reached out via phone at 801-322-3222.

Location: 344E 100S, Slc, UT, 84111
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790396554
Provider Name
Stephanie G Mishenko
Credential
Provider Entity Type
Individual
Gender
Female
Address
344E 100S, Slc, UT, 84111
Phone Number
801-322-3222
Fax Number
Provider Enumeration Date
08/13/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
17100000X 05 UT
institution
Provider Business Practice Location Address Details
Address
344E 100S
City
Slc
State
Utah
Zip
84111
Phone Number
801-322-3222
Fax Number
person
Provider Business Mailing Address Details
Address
344E 100S
City
Slc
State
Utah
Zip
84111
Phone Number
801-322-3222
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
(Utah)
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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