Healthcare Provider Details

I. General information

NPI: 1992358725
Provider Name (Legal Business Name): JILLIAN ROY STEVENS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 W MAGNOLIA BLVD
BURBANK CA
91505-3034
US

IV. Provider business mailing address

2900 S SEPULVEDA BLVD UNIT 202
LOS ANGELES CA
90064-4172
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-8000
  • Fax:
Mailing address:
  • Phone: 310-923-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: