Provider Demographics
NPI:1811518350
Name:STAMPER, MAJANETH OBISO
Entity type:Individual
Prefix:
First Name:MAJANETH
Middle Name:OBISO
Last Name:STAMPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 HOPEFUL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544
Mailing Address - Country:US
Mailing Address - Phone:330-488-5247
Mailing Address - Fax:
Practice Address - Street 1:200 J C JOHNSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-8678
Practice Address - Country:US
Practice Address - Phone:330-488-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1152984163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health