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General NPI Number Information
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NPI Number | 1528010345
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Entity Type | Individual
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Provider Name | JACKIE LYN STEPHENSON CNM
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 2702 NAVARRE AVE STE 305
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City | OREGON
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State | OH
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Zip | 43616-3224
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Country | US
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Telephone | 419-691-8000
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Fax | 419-693-0111
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Provider Business Mailing Address
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Address Line | 2200 JEFFERSON AVE 4TH FLOOR
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City | TOLEDO
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State | OH
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Zip | 43624-1120
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Country | US
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Telephone | 419-251-2673
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Fax | 419-251-0916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | NM07221
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License Number State | OH
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