Provider Demographics
NPI:1710300868
Name:QUINCY, STEPHANIE JANELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JANELLE
Last Name:QUINCY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:JANELLE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 933421
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:3333 W TECH RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0955
Practice Address - Country:US
Practice Address - Phone:937-641-5725
Practice Address - Fax:937-350-3050
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-155382-M-IV164W00000X
OHAPRN.CNP.0034554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0030609Medicaid