Healthcare Provider Details

I. General information

NPI: 1487831079
Provider Name (Legal Business Name): MARTY THYRONE STEIN JR. LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 EARLHAM DR
DAYTON OH
45406-4612
US

IV. Provider business mailing address

1627 EARLHAM DR
DAYTON OH
45406-4612
US

V. Phone/Fax

Practice location:
  • Phone: 937-276-5594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberPN120298-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: