MEDICARE: CHANEL STABLER

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	395734	OH

General Provider Information

NPI Number	:	1760883045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL STABLER

Provider Business Mailing Address
First Line	:	18301 DALEWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3514
Country	:	US
Telephone Number	:	216-212-6336
Fax Number	:

Provider Business Practice Location Address
First Line	:	18301 DALEWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3514
Country	:	US
Telephone Number	:	216-212-6336
Fax Number	:

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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Directions to “ CHANEL STABLER ” Practice Location

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