Provider Demographics
NPI:1336708908
Name:STEPHENSON, EVONNE B (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:EVONNE
Middle Name:B
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8573
Mailing Address - Country:US
Mailing Address - Phone:513-677-8855
Mailing Address - Fax:
Practice Address - Street 1:719 OHIO PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2131
Practice Address - Country:US
Practice Address - Phone:513-853-9700
Practice Address - Fax:513-892-8966
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0383163Medicaid
OH0362687Medicaid