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General NPI Number Information
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NPI Number | 1063727204
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Entity Type | Individual
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Provider Name | NICOLE L STEVENSON MSN-NPC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 1003 E ILLINOIS ST
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City | PETERSBURG
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State | IN
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Zip | 47567-8068
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Country | US
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Telephone | 812-354-3485
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Fax | 812-354-3459
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Provider Business Mailing Address
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Address Line | PO BOX 1028
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City | JASPER
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State | IN
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Zip | 47547-1028
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Country | US
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Telephone | 812-996-5255
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Fax | 812-996-8497
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71003367A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71003367A
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License Number State | IN
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