Healthcare Provider Details

I. General information

NPI: 1871007146
Provider Name (Legal Business Name): BENJAMIN ROBERT STEVENS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 E BELTLINE AVE NE STE 3
GRAND RAPIDS MI
49525-9316
US

IV. Provider business mailing address

2370 FARM CT SE
GRAND RAPIDS MI
49546-7932
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-9888
  • Fax:
Mailing address:
  • Phone: 616-644-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1035992
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704301140
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: