Healthcare Provider Details

I. General information

NPI: 1891371514
Provider Name (Legal Business Name): STEPHANIE A GIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE A GIBBS STEPHANIE GIBBS

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BACON ST
CINCINNATI OH
45215-2902
US

IV. Provider business mailing address

101 BACON ST
CINCINNATI OH
45215-2902
US

V. Phone/Fax

Practice location:
  • Phone: 513-915-5375
  • Fax:
Mailing address:
  • Phone: 513-915-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: