Most Relevant Information
Provider Data
| NPI Number: | 1003196114 |
| Provider Name: | STACY JO KLASS CNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | COA12426 |
Most Important Dates
| Enumeration Date: | 08/19/2011 |
| Last Updated: | 03/05/2018 |
Provider Practice Location
1005 BELLEFONTAINE AVE
SUITE 100
LIMA
OH
458042851
Practice Location Phone/Fax
| Phone: | 4192275298 |
| Fax: | 4192275879 |
Provider Mailing Location
951 COMMERCE PKWY
SUITE 101
LIMA
OH
458044040
Provider Mailing Phone/Fax
| Phone: | 4199984575 |
| Fax: | 4199984586 |