Healthcare Provider Details

I. General information

NPI: 1023522703
Provider Name (Legal Business Name): REBECCA STEVENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE STE 203
CRANSTON RI
02920-6043
US

IV. Provider business mailing address

1150 RESERVOIR AVE STE 203
CRANSTON RI
02920-6043
US

V. Phone/Fax

Practice location:
  • Phone: 401-259-0340
  • Fax:
Mailing address:
  • Phone: 401-259-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN02473
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN615165
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: