Healthcare Provider Details

I. General information

NPI: 1679217319
Provider Name (Legal Business Name): CHELSEA ROSE STEPHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 E PIKE RD
CAMBRIDGE OH
43725-8936
US

IV. Provider business mailing address

9711 E PIKE RD
CAMBRIDGE OH
43725-8936
US

V. Phone/Fax

Practice location:
  • Phone: 740-432-7440
  • Fax: 740-432-7424
Mailing address:
  • Phone: 740-432-7440
  • Fax: 740-432-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0031159
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: