Healthcare Provider Details

I. General information

NPI: 1326720210
Provider Name (Legal Business Name): STEPHANIE LYNN KIEFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 HIGHLAND AVE
SPRINGFIELD OH
45503-4608
US

IV. Provider business mailing address

1714 HIGHLAND AVE
SPRINGFIELD OH
45503-4608
US

V. Phone/Fax

Practice location:
  • Phone: 937-561-1636
  • Fax:
Mailing address:
  • Phone: 937-561-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: