Healthcare Provider Details

I. General information

NPI: 1922376748
Provider Name (Legal Business Name): JESSICA NICOLE STANKO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 11/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST EMERGENCY DEPARTMENT
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2830 VICTORY PARKWAY ML 0806 - CENTRAL CREDENTIALING
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5281
  • Fax: 513-558-5791
Mailing address:
  • Phone: 513-585-5505
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.12974
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: