Provider Demographics
NPI:1053676452
Name:GARRISON, STEPHANIE R (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 OLD BLUE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-2723
Mailing Address - Country:US
Mailing Address - Phone:513-385-2757
Mailing Address - Fax:
Practice Address - Street 1:5603 OLD BLUE ROCK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-2723
Practice Address - Country:US
Practice Address - Phone:513-253-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.129073-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH803621Medicaid
OH803621Medicaid