MEDICARE: MS. SARA ANNE STEVENS LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	I-07354	NM

General Provider Information

NPI Number	:	1891059879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA ANNE STEVENS LISW

Provider Business Mailing Address
First Line	:	727 7TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4238
Country	:	US
Telephone Number	:	505-454-3900
Fax Number	:	505-454-3961

Provider Business Practice Location Address
First Line	:	727 7TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4238
Country	:	US
Telephone Number	:	505-454-3900
Fax Number	:	505-454-3961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/25/2012

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