MEDICARE: JACKIE LYN STEPHENSON CNM

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	367A00000X	Advanced Practice Midwife	NM07221	OH

General Provider Information

NPI Number	:	1528010345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE LYN STEPHENSON CNM

Provider Business Mailing Address
First Line	:	2200 JEFFERSON AVE
Second Line	:	4TH FLOOR
City	:	TOLEDO
State	:	OH
Zip	:	43624-1120
Country	:	US
Telephone Number	:	419-251-2673
Fax Number	:	419-251-0916

Provider Business Practice Location Address
First Line	:	2702 NAVARRE AVE STE 305
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3224
Country	:	US
Telephone Number	:	419-691-8000
Fax Number	:	419-693-0111

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/01/2019

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