Doctor Name: | STACY JO KLASS |
NPI Number: | 1003196114 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | COA12426 |
Business Practice Address: | 1005 Bellefontaine Ave Suite 100 Lima, OH - 458042851 |
Business Phone Number: | 4192275298 |
Business Fax Number: | 4192275879 |
Mailing Address: | 951 Commerce Pkwy, Suite 101 LIMA |
State: | OH |
Postal Code: | 458044040 |
Phone Number: | 4199984575 |
Fax Number: | 4199984586 |
NPI Enumeration Date: | 08/19/2011 |
NPI Last Update Date: | 03/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | COA12426 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |