Healthcare Provider Details

I. General information

NPI: 1437971439
Provider Name (Legal Business Name): MARYANN YEMA STEVENSON MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9629 CHAPELCROFT ST
PHILADELPHIA PA
19115-3908
US

IV. Provider business mailing address

9629 CHAPELCROFT ST
PHILADELPHIA PA
19115-3908
US

V. Phone/Fax

Practice location:
  • Phone: 702-340-8248
  • Fax:
Mailing address:
  • Phone: 702-340-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN627243
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: