MEDICARE: STEPHANIE NICOLE WASSON 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	163W00000X	Registered Nurse	RN 364447	OH

General Provider Information

NPI Number	:	1588966774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE WASSON RN

Provider Business Mailing Address
First Line	:	1538 VISTA RIDGE DR
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3259
Country	:	US
Telephone Number	:	937-245-1056
Fax Number	:

Provider Business Practice Location Address
First Line	:	1538 VISTA RIDGE DR
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3259
Country	:	US
Telephone Number	:	937-245-1056
Fax Number	:

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

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	04/29/2014

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