Healthcare Provider Details

I. General information

NPI: 1275208019
Provider Name (Legal Business Name): MACY STEVENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E RUSHOLME ST
DAVENPORT IA
52803-2459
US

IV. Provider business mailing address

1801 E 54TH ST STE 100
DAVENPORT IA
52807-7214
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-1000
  • Fax:
Mailing address:
  • Phone: 563-421-0550
  • Fax: 563-421-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: