Healthcare Provider Details

I. General information

NPI: 1073196218
Provider Name (Legal Business Name): LAURA ANN STEVENS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 SHATTUCK WAY
NEWINGTON NH
03801-7879
US

IV. Provider business mailing address

177 SHATTUCK WAY
NEWINGTON NH
03801-7879
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-0448
  • Fax: 603-436-0668
Mailing address:
  • Phone: 603-436-0448
  • Fax: 603-436-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number017089-22
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: