Individual
STEPHANIE DALE GUAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
600 W MAIN ST STE 330, TROY, OH 45373-3384
(937) 429-7350
(937) 431-2623
Mailing address
2110 LEITER RD, MIAMISBURG, OH 45342-3598
(937) 914-7067
(937) 522-7513
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
COA10124NP
OH
363LW0102X
Women's Health Nurse Practitioner
Primary
10124
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3077790
—
OH
01
—
COA10124NP
OHIO LICENSE
OH
Enumeration date
11/21/2008
Last updated
03/08/2021
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