Provider Demographics
NPI:1528311453
Name:WATSON, STEPHANIE MICHELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:MICHELLE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 ANNABELLE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2406
Mailing Address - Country:US
Mailing Address - Phone:419-297-8731
Mailing Address - Fax:
Practice Address - Street 1:916 ANNABELLE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2406
Practice Address - Country:US
Practice Address - Phone:419-297-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.124282-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse