MEDICARE: STEPHANIE ELMORE RN

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	141293	OH
2	163W00000X	Registered Nurse	510343	OH

General Provider Information

NPI Number	:	1447505920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ELMORE RN

Provider Business Mailing Address
First Line	:	7171 KECK PARK CIR NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-6301
Country	:	US
Telephone Number	:	936-622-5304
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 JACKSON ST
Second Line	:
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-5030
Country	:	US
Telephone Number	:	936-622-5304
Fax Number	:

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	12/31/2024

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