Basic Information
| Provider Information | |||||||||
| NPI: | 1578004263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUMP | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3590 BUSENBARK RD | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | TRENTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450679552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139886369 | ||||||||
| FaxNumber: | 5139889369 | ||||||||
| Practice Location | |||||||||
| Address1: | 3590 BUSENBARK RD | ||||||||
| Address2: | #400 | ||||||||
| City: | TRENTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450679552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139886369 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2017 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 020527 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | APRNCNP020527 | 01 | OH | OHIO BOARD OF NURSING | OTHER | F02170090 | 01 | OH | AMERICAN ASSOCIATION OF NURSE PRACTITIONERS | OTHER |