Provider Demographics
NPI:1679175558
Name:STEPHENS, NICOLE RENEE (PERSONAL CARE AIDE)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PERSONAL CARE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BERNARD AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5509
Mailing Address - Country:US
Mailing Address - Phone:567-301-6418
Mailing Address - Fax:
Practice Address - Street 1:1205 BERNARD AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5509
Practice Address - Country:US
Practice Address - Phone:567-301-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2915724Medicaid