MEDICARE: MRS. STEPHANIE JEAN WARDLOW 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	RN307253	OH

General Provider Information

NPI Number	:	1790114932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE JEAN WARDLOW RN

Provider Business Mailing Address
First Line	:	231 ROBINETTE RD
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693-9715
Country	:	US
Telephone Number	:	937-779-9901
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 HIGHLAND S
Second Line	:
City	:	RUSSELLVILLE
State	:	OH
Zip	:	45168-1503
Country	:	US
Telephone Number	:	937-779-9901
Fax Number	:

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	12/28/2018

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