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General NPI Number Information
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NPI Number | 1114903168
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Entity Type | Individual
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Provider Name | MARY LOU STEVENS PAC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 750 WELLINGTON AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6132
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Country | US
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Telephone | 970-244-2457
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Fax | 970-255-1809
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | GRAND JUNCTION
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State | CO
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Zip | 81502-0062
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Country | US
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Telephone | 970-244-7050
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Fax | 970-255-1809
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2119
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License Number State | CO
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