Provider Demographics
NPI:1770030553
Name:STEFANKO, CARA (CNP)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:STEFANKO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8957
Mailing Address - Country:US
Mailing Address - Phone:740-881-0012
Mailing Address - Fax:
Practice Address - Street 1:4575 CASCADE DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8957
Practice Address - Country:US
Practice Address - Phone:740-881-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH289335163W00000X
OHAPRN.CNP.019668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse