Provider Demographics
NPI:1710732789
Name:ALPHA, STELLA FATMATA (RN)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:FATMATA
Last Name:ALPHA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6142 NORTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2400
Mailing Address - Country:US
Mailing Address - Phone:614-698-6698
Mailing Address - Fax:
Practice Address - Street 1:6142 NORTHGATE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2400
Practice Address - Country:US
Practice Address - Phone:614-698-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.494318163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health