Maryjane NP Inc

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

MARYJANE NP INC

Practice address

3830 Woodridge Blvd Ste C
Fairfield, OH 45014-7564

Phone

(702) 907-2733

NPI assigned

Jul 22, 2019

Last updated

Jul 22, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Evonne B Stephenson, APRN-CNPNPI 1336708908

Title

Family Nurse Practitioner

Phone

(513) 677-8855

Specialties & licenses 1

Addresses

Other names 1

• Evonne B Stephenson Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Evonne B Stephenson, FNP-C, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • New Vienna, OH
  • NPI 1336708908
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563753600000",
    "number": "1538712393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6370 IRONWOOD DR",
            "city": "LOVELAND",
            "state": "OH",
            "postal_code": "451408573",
            "telephone_number": "513-677-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 WOODRIDGE BLVD STE C",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450147564",
            "telephone_number": "702-907-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYJANE NP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "EVONNE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "513-677-8855",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN-CNP"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evonne B Stephenson",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Grace A. Marshall, CDCA
• Larry Steven Martin, DDS
• Lori Martin, RN
• Sabrina Martin
• Stephen William Martinkovic, DDS
• Chasity Mason
• Cynthia M Mason
• Fadi S. Masoud, D.D.S., M.S.
• Hortense Massa
• Keeleigh Masters, LISW-S

• Pain Clinic/Center in Fairfield, OH
• Providers in Fairfield, OH by specialty
• Pain Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.