Basic Information
Provider Information | |||||||||
NPI: | 1841631629 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEFF | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | STACHLER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN, ACNS-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STACHLER | ||||||||
OtherFirstName: | JULIE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 30 E APPLE ST | ||||||||
Address2: | SUITE 5254A | ||||||||
City: | DAYTON | ||||||||
State: | OH | ||||||||
PostalCode: | 454092939 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9372084200 | ||||||||
FaxNumber: | 9372084205 | ||||||||
Practice Location | |||||||||
Address1: | 30 E APPLE ST | ||||||||
Address2: | SUITE 5254A | ||||||||
City: | DAYTON | ||||||||
State: | OH | ||||||||
PostalCode: | 454092939 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9372084200 | ||||||||
FaxNumber: | 9372084205 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/09/2013 | ||||||||
LastUpdateDate: | 05/21/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | COA.14737-NS | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
ID Information
ID | Type | State | Issuer | Description | 0098102 | 05 | OH |   | MEDICAID |