Healthcare Provider Details

I. General information

NPI: 1336594894
Provider Name (Legal Business Name): GWENLOU ARLISE STEVENS HEALTH TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MERCANTILE LN STE 100L
LARGO MD
20774-5390
US

IV. Provider business mailing address

1300 MERCANTILE LN STE 100L
LARGO MD
20774-5390
US

V. Phone/Fax

Practice location:
  • Phone: 301-404-3532
  • Fax: 301-404-3532
Mailing address:
  • Phone: 301-404-3532
  • Fax: 301-043-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: