Provider Demographics
NPI:1104410646
Name:FERNALD, STEPHANIE MEADE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MEADE
Last Name:FERNALD
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 HEALTHWAY DR # 203
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2834
Mailing Address - Country:US
Mailing Address - Phone:440-695-6503
Mailing Address - Fax:
Practice Address - Street 1:1997 HEALTHWAY DR # 203
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2834
Practice Address - Country:US
Practice Address - Phone:440-695-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily