MEDICARE: JULIUS J STEVENS STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide
2	376K00000X	Nurse's Aide	400355670504	OH

General Provider Information

NPI Number	:	1366915456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIUS J STEVENS STNA

Provider Business Mailing Address
First Line	:	1317 CLAY ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-7659
Country	:	US
Telephone Number	:	513-373-7478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 CLAY ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-7659
Country	:	US
Telephone Number	:	513-373-7478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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