Individual
STEPHANIE FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3211 MONTE VISTA BLVD NE, ALBUQUERQUE, NM 87106-2119
(505) 268-3520
Mailing address
712 ADAMS ST NE, ALBUQUERQUE, NM 87110-6224
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2632
NM
225X00000X
Occupational Therapist
1943
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26903318
—
NM
Enumeration date
12/12/2006
Last updated
09/11/2025
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