Provider Demographics
NPI:1427665827
Name:CROSS, STEPHANE C (RN)
Entity type:Individual
Prefix:MR
First Name:STEPHANE
Middle Name:C
Last Name:CROSS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 BRIDGEPORT AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4058
Mailing Address - Country:US
Mailing Address - Phone:216-278-5131
Mailing Address - Fax:
Practice Address - Street 1:775 BRIDGEPORT AVE APT 306
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4058
Practice Address - Country:US
Practice Address - Phone:216-278-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor