Provider Demographics
NPI:1659616506
Name:ADAMS, STEPHANI BLAIR (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:BLAIR
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10570 DEEP CUT RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-8006
Mailing Address - Country:US
Mailing Address - Phone:614-653-9426
Mailing Address - Fax:
Practice Address - Street 1:4887 CHERRY CREEK PKWY S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-2759
Practice Address - Country:US
Practice Address - Phone:614-853-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151236164W00000X
OH41171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse