Provider Demographics
NPI:1851569750
Name:BRONAUGH, STEPHANIE DUJUAN (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DUJUAN
Last Name:BRONAUGH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 HUNTSVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2516
Mailing Address - Country:US
Mailing Address - Phone:937-671-0609
Mailing Address - Fax:
Practice Address - Street 1:7310 HUNTSVIEW CT
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2516
Practice Address - Country:US
Practice Address - Phone:937-671-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 106161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse