Provider Demographics
NPI:1902081268
Name:STEPHENS, FANNYE MAE (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:MRS
First Name:FANNYE
Middle Name:MAE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223
Mailing Address - Country:US
Mailing Address - Phone:513-681-3657
Mailing Address - Fax:513-681-3657
Practice Address - Street 1:4320 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223
Practice Address - Country:US
Practice Address - Phone:513-681-3657
Practice Address - Fax:513-681-3657
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2712452Medicaid