Provider Demographics
NPI:1427225093
Name:MARTIN, STEPHANIE RAE (MSN, CNS, APRN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN, CNS, APRN
Other - Prefix:
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Mailing Address - Street 1:260 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2034
Mailing Address - Country:US
Mailing Address - Phone:330-350-1291
Mailing Address - Fax:
Practice Address - Street 1:624 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1017
Practice Address - Country:US
Practice Address - Phone:330-493-4553
Practice Address - Fax:330-493-3761
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNS.03541163WP0809X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult