Healthcare Provider Details

I. General information

NPI: 1639977598
Provider Name (Legal Business Name): VANESSA PAIGE STITZLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N UNION ST
LOUDONVILLE OH
44842-1074
US

IV. Provider business mailing address

4941 STATE ROUTE 514
GLENMONT OH
44628-9724
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-3111
  • Fax:
Mailing address:
  • Phone: 330-231-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: