Healthcare Provider Details

I. General information

NPI: 1134715907
Provider Name (Legal Business Name): STEPHEN JANSSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 08/17/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 BURNET AVE
CINCINNATI OH
45229-3091
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8600
  • Fax: 513-584-8619
Mailing address:
  • Phone: 513-585-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027198
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: