Provider Demographics
NPI:1477307072
Name:HANSEL, STEPHANIE ANNA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNA
Last Name:HANSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4974 SALTON DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-6444
Mailing Address - Country:US
Mailing Address - Phone:121-632-2555
Mailing Address - Fax:
Practice Address - Street 1:4974 SALTON DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-6444
Practice Address - Country:US
Practice Address - Phone:121-632-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6771753747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant