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General NPI Number Information
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NPI Number | 1972813830
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Entity Type | Individual
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Provider Name | STEPHANIE KRUEGER-MAXWELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 85 N GRAND AVE
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City | FORT THOMAS
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State | KY
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Zip | 41075-1793
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Country | US
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Telephone | 859-572-3617
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Fax | 859-572-2326
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Provider Business Mailing Address
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Address Line | PO BOX 638685
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City | CINCINNATI
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State | OH
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Zip | 45263-8685
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Country | US
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Telephone | 877-882-5644
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Fax | 833-643-8146
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1612
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License Number State | KY
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