Provider Demographics
NPI:1649700196
Name:STAHL, CHRISTINE NICHOLE (CNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NICHOLE
Last Name:STAHL
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 1:10 REMICK BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9168
Mailing Address - Country:US
Mailing Address - Phone:937-531-0124
Mailing Address - Fax:937-531-0129
Practice Address - Street 1:10 REMICK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9168
Practice Address - Country:US
Practice Address - Phone:937-531-0124
Practice Address - Fax:937-531-0129
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227973Medicaid