Healthcare Provider Details

I. General information

NPI: 1962439679
Provider Name (Legal Business Name): EVA STEPHENS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVA VANN NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251B SARATOGA AVE NE
WASHINGTON DC
20018-1025
US

IV. Provider business mailing address

906 ASPEN ST NW
WASHINGTON DC
20012-2512
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8818
  • Fax: 202-832-8575
Mailing address:
  • Phone: 202-806-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number256765
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR103027
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN53673
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: