Healthcare Provider Details

I. General information

NPI: 1457698847
Provider Name (Legal Business Name): MS. KOWANIS STEVENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2013
Last Update Date: 01/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7636 GATSBY HOUSE ST
LAS VEGAS NV
89166-5116
US

IV. Provider business mailing address

7636 GATSBY HOUSE ST
LAS VEGAS NV
89166-5116
US

V. Phone/Fax

Practice location:
  • Phone: 702-523-8179
  • Fax:
Mailing address:
  • Phone: 702-523-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: