Provider Demographics
NPI:1053741702
Name:EGGERT, STEPHANIE NOEL
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NOEL
Last Name:EGGERT
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 1:3333 BURNET AVE
Mailing Address - Street 2:ML 6015
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-9900
Mailing Address - Fax:513-803-0823
Practice Address - Street 1:5642 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3114
Practice Address - Country:US
Practice Address - Phone:513-636-9900
Practice Address - Fax:513-803-0823
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.291517-COA1364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013017823OtherANCC
2013017823OtherANCC