MEDICARE: MRS. FANNYE MAE STEPHENS HOME HEALTH AIDE

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	374U00000X	Home Health Aide		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902081268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FANNYE MAE STEPHENS HOME HEALTH AIDE

Provider Business Mailing Address
First Line	:	4320 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223
Country	:	US
Telephone Number	:	513-681-3657
Fax Number	:	513-681-3657

Provider Business Practice Location Address
First Line	:	4320 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223
Country	:	US
Telephone Number	:	513-681-3657
Fax Number	:	513-681-3657

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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