Healthcare Provider Details

I. General information

NPI: 1376200303
Provider Name (Legal Business Name): STEVIE BLISS GHIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 E COOKE RD
COLUMBUS OH
43224-2109
US

IV. Provider business mailing address

1628 E COOKE RD
COLUMBUS OH
43224-2109
US

V. Phone/Fax

Practice location:
  • Phone: 614-372-9363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberHIC03333
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberHIC03333
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: