MEDICARE: STEPHANIE R GARRISON LPN

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	164W00000X	Licensed Practical Nurse	PN.129073-M-IV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053676452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE R GARRISON LPN

Provider Business Mailing Address
First Line	:	5603 OLD BLUE ROCK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-2723
Country	:	US
Telephone Number	:	513-385-2757
Fax Number	:

Provider Business Practice Location Address
First Line	:	5603 OLD BLUE ROCK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-2723
Country	:	US
Telephone Number	:	513-253-8072
Fax Number	:

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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Directions to “ STEPHANIE R GARRISON LPN” Practice Location

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