Provider Demographics
NPI:1053201442
Name:SETVIN STULL, JAZIMINE SHANNTEL
Entity type:Individual
Prefix:
First Name:JAZIMINE
Middle Name:SHANNTEL
Last Name:SETVIN STULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-3838
Mailing Address - Country:US
Mailing Address - Phone:330-691-6627
Mailing Address - Fax:
Practice Address - Street 1:249 COLONIAL AVE SE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2350
Practice Address - Country:US
Practice Address - Phone:330-401-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide