MEDICARE: STEPHANIE MARIE KING APRN

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.0036130	OH

General Provider Information

NPI Number	:	1912547332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE KING APRN

Provider Business Mailing Address
First Line	:	20230 GLEN RUSS LN
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-2417
Country	:	US
Telephone Number	:	162-374-3037
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2417
Country	:	US
Telephone Number	:	216-986-4000
Fax Number	:

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

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	01/23/2025

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