| NPI | 1992470124 |
|---|---|
| Former Name | STEPHANIE CHRISTINE BROADWATER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0029424) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2024-04-03 |