Healthcare Provider Details

I. General information

NPI: 1992121768
Provider Name (Legal Business Name): JOANNA STUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 BRIDGEPORT DR
HAMILTON OH
45013-5193
US

IV. Provider business mailing address

2171 BRIDGEPORT DR
HAMILTON OH
45013-5193
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-5580
  • Fax: 513-868-5585
Mailing address:
  • Phone: 513-868-5580
  • Fax: 513-868-5585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number393311
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: