Provider Demographics
NPI:1184864035
Name:STEPHERSON, MONICA L (CNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:STEPHERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LEANN
Other - Last Name:STEPHERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:2489 STELZER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-4007
Mailing Address - Country:US
Mailing Address - Phone:614-473-1300
Mailing Address - Fax:614-473-0722
Practice Address - Street 1:2489 STELZER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-4007
Practice Address - Country:US
Practice Address - Phone:614-473-1300
Practice Address - Fax:614-473-0722
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164225Medicaid
OHH296560Medicare PIN