Healthcare Provider Details

I. General information

NPI: 1912618919
Provider Name (Legal Business Name): ALLISON FAYE STEVENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 N LOTZ RD
CANTON MI
48187-4331
US

IV. Provider business mailing address

47617 VISTAS CIRCLE DR N
CANTON MI
48188-1484
US

V. Phone/Fax

Practice location:
  • Phone: 734-394-4500
  • Fax:
Mailing address:
  • Phone: 734-751-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703104528
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: