Healthcare Provider Details

I. General information

NPI: 1467702555
Provider Name (Legal Business Name): ANITA KAE STIVER STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2012
Last Update Date: 09/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PHILLIPSBURG UNION RD
UNION OH
45322-9750
US

IV. Provider business mailing address

115 PHILLIPSBURG UNION RD
UNION OH
45322-9750
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-6411
  • Fax:
Mailing address:
  • Phone: 937-836-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401025540110
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: