Healthcare Provider Details

I. General information

NPI: 1629111232
Provider Name (Legal Business Name): DAVID M. STEVENSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 CHESHIRE ROAD
WALLINGFORD CT
06492-0649
US

IV. Provider business mailing address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-2370
  • Fax: 203-626-5622
Mailing address:
  • Phone: 203-932-6481
  • Fax: 203-932-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2031
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number002031
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: