Provider Demographics
NPI:1043723919
Name:DENT, STANETTA STEPHENIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STANETTA
Middle Name:STEPHENIE
Last Name:DENT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:STANETTA
Other - Middle Name:STEPHENIE
Other - Last Name:DENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:390 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1272
Mailing Address - Country:US
Mailing Address - Phone:614-515-1392
Mailing Address - Fax:
Practice Address - Street 1:390 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1272
Practice Address - Country:US
Practice Address - Phone:614-515-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse