Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN 243561 | OH |
NPI | 1144530759 |
---|---|
Provider Name | Stacey Stephenson |
First Address | Amelia, OH 45102 |
Second Address | Cincinnati, OH 45255-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2010 |
Last Update Date | 23/04/2015 |