Basic Information
| Provider Information | |||||||||
| NPI: | 1124215819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVALCHIK | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 VICTORY PKWY | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453072 | ||||||||
| FaxNumber: | 5135855511 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SEAMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456798002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758521 | ||||||||
| FaxNumber: | 5134757480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | COA16591NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 364SA2100X | 5323P | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care | 363LA2100X | APRN.CNP.16591 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.