Healthcare Provider Details

I. General information

NPI: 1558278531
Provider Name (Legal Business Name): STEPHANIE RENEE CRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SPENCER ST
VAN WERT OH
45891-2510
US

IV. Provider business mailing address

717 SPENCER ST
VAN WERT OH
45891-2510
US

V. Phone/Fax

Practice location:
  • Phone: 419-771-9848
  • Fax: 419-771-9848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.535711
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: