Healthcare Provider Details

I. General information

NPI: 1164672614
Provider Name (Legal Business Name): JANET M. STEVENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E 10TH ST
ROLLA MO
65401-3648
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-7551
  • Fax: 573-364-4898
Mailing address:
  • Phone: 660-885-8131
  • Fax: 660-885-2393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number063365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: