MEDICARE: STACIE DEL STEVENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	601948630223	OH

General Provider Information

NPI Number	:	1043191265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE DEL STEVENSON

Provider Business Mailing Address
First Line	:	5930 RED OAK DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1841
Country	:	US
Telephone Number	:	419-464-4453
Fax Number	:

Provider Business Practice Location Address
First Line	:	5930 RED OAK DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1841
Country	:	US
Telephone Number	:	419-464-4453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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Directions to “ STACIE DEL STEVENSON ” Practice Location

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