Healthcare Provider Details

I. General information

NPI: 1235831801
Provider Name (Legal Business Name): STEPHANIE JEAN O'KRESIK JEWETTE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 E MARKET ST
WARREN OH
44484-2260
US

IV. Provider business mailing address

1060 S HERMITAGE RD
HERMITAGE PA
16148-3621
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-8000
  • Fax:
Mailing address:
  • Phone: 808-352-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.018778
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: