Provider Demographics
NPI:1578214649
Name:BLEVINS, STEPHANIE L (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E GORGAS ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-1725
Mailing Address - Country:US
Mailing Address - Phone:330-417-4302
Mailing Address - Fax:
Practice Address - Street 1:725 E GORGAS ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1725
Practice Address - Country:US
Practice Address - Phone:330-417-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123620164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse