Provider Demographics
NPI:1043449457
Name:RICHMOND, STACIE E (RN, CNP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:E
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:E
Other - Last Name:OHMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 2008
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-7966
Mailing Address - Fax:513-636-7967
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 2008
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-7966
Practice Address - Fax:513-636-7967
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10895-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics