Healthcare Provider Details

I. General information

NPI: 1154839322
Provider Name (Legal Business Name): STEPHANIE VISJAGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 MONTGOMERY RD STE 250
CINCINNATI OH
45249-2395
US

IV. Provider business mailing address

2617 DEVILS BACKBONE RD
CINCINNATI OH
45233-4422
US

V. Phone/Fax

Practice location:
  • Phone: 513-547-2861
  • Fax: 513-880-0595
Mailing address:
  • Phone: 513-467-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0030186
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.2775524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: