Healthcare Provider Details

I. General information

NPI: 1205050341
Provider Name (Legal Business Name): MRS. MAUREEN MARGARET STULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 S NIXON CAMP RD
LEBANON OH
45036-9638
US

IV. Provider business mailing address

1560 S NIXON CAMP RD
LEBANON OH
45036-9638
US

V. Phone/Fax

Practice location:
  • Phone: 513-933-9179
  • Fax:
Mailing address:
  • Phone: 513-933-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number320900000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: