Healthcare Provider Details

I. General information

NPI: 1881082485
Provider Name (Legal Business Name): EUDINE STEVENS CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROADWAY ST NW
CONDE SD
57434-2017
US

IV. Provider business mailing address

PO BOX 63
CONDE SD
57434-0063
US

V. Phone/Fax

Practice location:
  • Phone: 406-939-1960
  • Fax:
Mailing address:
  • Phone: 406-939-1960
  • Fax: 877-922-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60568305
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002102
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: