Healthcare Provider Details

I. General information

NPI: 1770136053
Provider Name (Legal Business Name): TAMMY STEVENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY STEVENSON REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 CHEROKEE ST
DENVER CO
80204-3632
US

IV. Provider business mailing address

5532 S YAKIMA ST
AURORA CO
80015-6538
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-3500
  • Fax:
Mailing address:
  • Phone: 720-839-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number0197115
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: