Healthcare Provider Details

I. General information

NPI: 1912600131
Provider Name (Legal Business Name): CORI LEA STEVENS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 CAPRICORN WAY STE 207
SANTA ROSA CA
95407-5486
US

IV. Provider business mailing address

2227 CAPRICORN WAY STE 207
SANTA ROSA CA
95407-5486
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: