Provider Demographics
NPI:1780171637
Name:LIETTE, STEPHANIE LEE (DPM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:LIETTE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEE
Other - Last Name:PETROFSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-0175
Mailing Address - Fax:859-746-7464
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4895
Practice Address - Country:US
Practice Address - Phone:859-212-0175
Practice Address - Fax:859-746-7464
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36004004213E00000X
IN07001411A213ES0103X
390200000X
KY281873213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program