Healthcare Provider Details

I. General information

NPI: 1770030553
Provider Name (Legal Business Name): CARA STEFANKO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 CASCADE DR
POWELL OH
43065-8957
US

IV. Provider business mailing address

4575 CASCADE DR
POWELL OH
43065-8957
US

V. Phone/Fax

Practice location:
  • Phone: 740-881-0012
  • Fax:
Mailing address:
  • Phone: 740-881-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019668
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number289335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: