Provider Demographics
NPI:1972682912
Name:SPICER, STEFANIE MARIE (CNP)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:MARIE
Last Name:SPICER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932100
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0008
Mailing Address - Country:US
Mailing Address - Phone:216-472-2730
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1000
Practice Address - Fax:330-471-5937
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN251257/ NP05095363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
501710OtherANTHEM/BCBS
OH000000342106OtherANTHEM
P00379956OtherRAILROAD
OH2525753Medicaid
OH2544616Medicaid
OHP00185489OtherRAILROAD
OHP00185489OtherRAILROAD
OHQ18748Medicare UPIN
OH2544616Medicaid