Healthcare Provider Details

I. General information

NPI: 1518442599
Provider Name (Legal Business Name): HEATHER MARIE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 US HIGHWAY 62 NE
MOUNT STERLING OH
43143-9658
US

IV. Provider business mailing address

12600 US HIGHWAY 62 NE
MOUNT STERLING OH
43143-9658
US

V. Phone/Fax

Practice location:
  • Phone: 740-506-5671
  • Fax:
Mailing address:
  • Phone: 740-506-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.443900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: