| NPI | 1164702320 |
|---|---|
| Former Name | STEPHANIE R. BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.12539-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.12539) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2024-02-19 |