Healthcare Provider Details

I. General information

NPI: 1770607608
Provider Name (Legal Business Name): ABBIE LAUREL STEVENSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 KIRMAN AVE STE 403
RENO NV
89502-1362
US

IV. Provider business mailing address

1190 HARDESTY DR
RENO NV
89509-3116
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-4589
  • Fax: 775-322-3787
Mailing address:
  • Phone: 775-329-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-178
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: