Provider Demographics
NPI:1871509802
Name:CRIPPS, STEPHANIE RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:CRIPPS
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 1:9015 ASHLEY RD
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43003-9734
Mailing Address - Country:US
Mailing Address - Phone:740-413-4017
Mailing Address - Fax:
Practice Address - Street 1:9015 ASHLEY RD
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:OH
Practice Address - Zip Code:43003-9734
Practice Address - Country:US
Practice Address - Phone:740-413-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN090459164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2266784Medicaid