Provider Demographics
NPI:1932670833
Name:SINGLETON, STEPHANIE DESIREE (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DESIREE
Last Name:SINGLETON
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 1:5120 RIDGE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-1130
Mailing Address - Country:US
Mailing Address - Phone:330-785-5902
Mailing Address - Fax:
Practice Address - Street 1:5120 RIDGE AVE SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-1130
Practice Address - Country:US
Practice Address - Phone:330-785-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.411202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty