1609482355 NPI number — JACQUELINE B STEVENS CPT PHLEBOTOMIST TEC

Table of content: JACQUELINE B STEVENS CPT PHLEBOTOMIST TEC (NPI 1609482355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609482355 NPI number — JACQUELINE B STEVENS CPT PHLEBOTOMIST TEC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
JACQUELINE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPT PHLEBOTOMIST TEC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609482355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 BERCLIFF AVE #1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-918-0398
Provider Business Mailing Address Fax Number:
513-376-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1172 W GALBRAITH RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-202-3729
Provider Business Practice Location Address Fax Number:
513-541-2198
Provider Enumeration Date:
09/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246RP1900X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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