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NPI Code Detail

MEDICARE: MISS JELISSA STURDIVANT

MEDICARE: MISS JELISSA STURDIVANT
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
1374U00000XHome Health Aide
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1306295423
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JELISSA STURDIVANT
Provider Business Mailing Address
First Line : 1044 SPRINGBROOK DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45224-1658
Country : US
Telephone Number : 513-704-8314
Fax Number :
Provider Business Practice Location Address
First Line : 3650 MUDDY CREEK RD STE 100
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-2058
Country : US
Telephone Number : 513-347-0375
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2016
Last Update Date : 09/17/2024

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Directions to “ MISS JELISSA STURDIVANT ” Practice Location

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