Individual
STEPHANIE DETAMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1811 W 2ND ST STE 450, GRAND ISLAND, NE 68803-5473
(308) 379-8619
Mailing address
1811 W 2ND ST STE 450, GRAND ISLAND, NE 68803-5473
(308) 379-8619
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/07/2022
Last updated
02/07/2022
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