Healthcare Provider Details

I. General information

NPI: 1447344650
Provider Name (Legal Business Name): DOUGLAS FRANK STEVENS M.S.,R.N.,C.W.O.C.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1506 LAUREL AVE APT. #1
SAINT PAUL MN
55104-7488
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-3565
  • Fax:
Mailing address:
  • Phone: 651-646-1173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberR099903-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: