Provider Demographics
NPI:1972187060
Name:STEPHENSON, JAMIE NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:NICOLE
Last Name:STEPHENSON
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 1:1908 W CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-8938
Mailing Address - Country:US
Mailing Address - Phone:765-366-3117
Mailing Address - Fax:
Practice Address - Street 1:1908 W CRESCENT DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-8938
Practice Address - Country:US
Practice Address - Phone:765-366-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27075564A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse