Provider Demographics
NPI:1790114932
Name:WARDLOW, STEPHANIE JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEAN
Last Name:WARDLOW
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 1:231 ROBINETTE RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9715
Mailing Address - Country:US
Mailing Address - Phone:937-779-9901
Mailing Address - Fax:
Practice Address - Street 1:50 HIGHLAND S
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:45168-1503
Practice Address - Country:US
Practice Address - Phone:937-779-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN307253163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse