Provider Demographics
NPI:1982935011
Name:STEPHENS, TODD BRANDON (LPN)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:BRANDON
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W SANDUSKY ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-1254
Mailing Address - Country:US
Mailing Address - Phone:740-507-1637
Mailing Address - Fax:
Practice Address - Street 1:170 W SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-1254
Practice Address - Country:US
Practice Address - Phone:740-507-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137563164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse