Provider Demographics
NPI:1497517262
Name:DUBOSE REEVES, STEPHANIE LOUISE
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:DUBOSE REEVES
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 1:5788 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-3549
Mailing Address - Country:US
Mailing Address - Phone:513-708-3798
Mailing Address - Fax:513-829-4999
Practice Address - Street 1:5788 RED OAK DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3549
Practice Address - Country:US
Practice Address - Phone:513-708-3798
Practice Address - Fax:513-829-4999
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X, 3747P1801X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide