Healthcare Provider Details

I. General information

NPI: 1134542343
Provider Name (Legal Business Name): MARIE STEVENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 E GRAND BLVD STE 600 PMB 1042
DETROIT MI
48202
US

IV. Provider business mailing address

1571 SUNDOWN DR
HENDERSON NV
89002-8843
US

V. Phone/Fax

Practice location:
  • Phone: 231-239-6101
  • Fax: 231-251-8267
Mailing address:
  • Phone: 231-239-6101
  • Fax: 231-251-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number5601012176
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012176
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: