Individual
STEPHANIE TICER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(571) 231-3224
Mailing address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689124521
—
WA
Enumeration date
10/04/2016
Last updated
07/15/2019
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