Provider Demographics
NPI:1659604056
Name:STEPHENS, JILL C (LPN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:STEPHENS
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 1:4375 COUNTY ROAD L
Mailing Address - Street 2:
Mailing Address - City:MC CLURE
Mailing Address - State:OH
Mailing Address - Zip Code:43534-9782
Mailing Address - Country:US
Mailing Address - Phone:419-748-8702
Mailing Address - Fax:
Practice Address - Street 1:600 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9038
Practice Address - Country:US
Practice Address - Phone:419-599-1660
Practice Address - Fax:419-592-8336
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN107811-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse