Healthcare Provider Details

I. General information

NPI: 1871874982
Provider Name (Legal Business Name): RUBY VIRGINIA STEVENSON TEACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71767 BUCKHORN RD
MONTROSE CO
81403-8708
US

IV. Provider business mailing address

71767 BUCKHORN RD
MONTROSE CO
81403-8708
US

V. Phone/Fax

Practice location:
  • Phone: 970-240-1992
  • Fax:
Mailing address:
  • Phone: 970-240-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number0408011
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: