Basic Information
| Provider Information | |||||||||
| NPI: | 1841657079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEIBLE | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 MARKET ST. | ||||||||
| Address2: | OFFICE 19A 126 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154032156 | ||||||||
| FaxNumber: | 8457036297 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 TREE LINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | GIBSONIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109912818 | ||||||||
| FaxNumber: | 8457036297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 04/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F340180 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.