Healthcare Provider Details

I. General information

NPI: 1710134077
Provider Name (Legal Business Name): STEPHANIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 4002
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE MLC 4002
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-8059
  • Fax: 513-636-7743
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN 272539
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: