Provider Demographics
NPI:1194816934
Name:TIMMONS, STEPHANIE MACMILLAN (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MACMILLAN
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MICHIGAN DR
Mailing Address - Street 2:
Mailing Address - City:TERRACE PARK
Mailing Address - State:OH
Mailing Address - Zip Code:45174-1148
Mailing Address - Country:US
Mailing Address - Phone:513-226-2300
Mailing Address - Fax:
Practice Address - Street 1:2570 MADISON RD
Practice Address - Street 2:APT. 13
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1157
Practice Address - Country:US
Practice Address - Phone:513-226-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 308737163W00000X
OHNP-09017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse