Provider Demographics
NPI:1548959612
Name:GILLIAM, STEPHANIE SUE (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN LENORA ISAACS
Mailing Address - Street 2:2100 STELLA CT
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-502-7812
Mailing Address - Fax:614-252-7987
Practice Address - Street 1:ATTN LENORA ISAACS
Practice Address - Street 2:2100 STELLA CT
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1011
Practice Address - Country:US
Practice Address - Phone:614-502-7812
Practice Address - Fax:614-252-7987
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185195164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse