Provider Demographics
NPI:1629623111
Name:SYLVIA-STEPHENS, QIANA (CNP)
Entity Type:Individual
Prefix:
First Name:QIANA
Middle Name:
Last Name:SYLVIA-STEPHENS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:QIANA
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:765 PIERCE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:765 PIERCE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2425
Practice Address - Country:US
Practice Address - Phone:614-223-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61469321163WP0808X
NY844814163WP0808X
OHRN.311795163WP0808X
NJ26NR25212100163WP0808X
NY404585363LP0808X
WAAP61469322363LP0808X
NJ26NJ14932800363LP0808X
OHAPRN.CNP.025585363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371447Medicaid