| Doctor Name: | MRS. STEPHANIE RAE DATEMA |
| NPI Number: | 1013344779 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN-76978 |
| Business Practice Address: | 516 E Nizhoni Blvd Gallup, NM - 873015748 |
| Business Phone Number: | 5057221000 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1337, GALLUP |
| State: | NM |
| Postal Code: | 873051337 |
| Phone Number: | 5057221165 |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2013 |
| NPI Last Update Date: | 09/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WE0003X |
| License Number: | RN-76978 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Emergency |
| Taxonomy Definition: | |