Healthcare Provider Details

I. General information

NPI: 1629180070
Provider Name (Legal Business Name): VERONICA FREDERICK STEVENS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VERONICA FREDERICK STEVENS FNP

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 SEMINARY STREET
KENANSVILLE NC
28349-0948
US

IV. Provider business mailing address

361 SOUTH CARROLLS ROAD
WARSAW NC
28398-7605
US

V. Phone/Fax

Practice location:
  • Phone: 910-296-2130
  • Fax:
Mailing address:
  • Phone: 910-293-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201482
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: