Healthcare Provider Details

I. General information

NPI: 1285885863
Provider Name (Legal Business Name): JANE E STEVENSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S GILBERT RD STE 101
GILBERT AZ
85296-2261
US

IV. Provider business mailing address

4600 S MILL AVE SUITE 280
TEMPE AZ
85282
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 480-677-8283
Mailing address:
  • Phone: 480-305-2888
  • Fax: 480-305-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4282
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: