Healthcare Provider Details

I. General information

NPI: 1609482355
Provider Name (Legal Business Name): JACQUELINE B STEVENS CPT PHLEBOTOMIST TEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 W GALBRAITH RD SUITE 110
CINCINNATI OH
45231
US

IV. Provider business mailing address

1430 BERCLIFF AVE #1
CINCINNATI OH
45223
US

V. Phone/Fax

Practice location:
  • Phone: 513-202-3729
  • Fax: 513-541-2198
Mailing address:
  • Phone: 513-918-0398
  • Fax: 513-376-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: