Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 35056000 | OH |
NPI | 1164476263 |
---|---|
Provider Name | Dr. Susan Ellen Stephens |
First Address | Concord Twp, OH 44077-9621 |
Second Address | Concord Twp, OH 44077-9621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0880480 | (05) | OH |
F28178 | (02) | OH |