Provider Demographics
NPI:1447732904
Name:STANG, JESSICA (STUDENT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STANG
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 YANKEE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9126
Mailing Address - Country:US
Mailing Address - Phone:513-312-3486
Mailing Address - Fax:
Practice Address - Street 1:555 BORROR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1187
Practice Address - Country:US
Practice Address - Phone:800-273-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program