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General NPI Number Information
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NPI Number | 1245255421
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Entity Type | Individual
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Provider Name | JOEL THOMAS STEVENS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 856 MANKATO AVE
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City | WINONA
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State | MN
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Zip | 55987
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Country | US
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Telephone | 507-864-7726
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Fax | 507-864-2668
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Provider Business Mailing Address
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Address Line | PO BOX 579 WINONA HEALTH PHYSICIAN CLINICS 212 S MILL ST
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City | RUSHFORD
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State | MN
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Zip | 55971-0579
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Country | US
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Telephone | 507-864-7726
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Fax | 507-864-2668
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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 | 001596
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License Number State | IA
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