=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477864510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA B STEVENS, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2010
-----------------------------------------------------
Last Update Date | 06/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 172 ROSEWOOD AVE
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520-6701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-332-2417
-----------------------------------------------------
Fax | 307-332-2417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 172 ROSEWOOD AVE
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520-6701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-332-2417
-----------------------------------------------------
Fax | 307-332-2417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT,ONLYOFFICER,ONLY EMPLOYEE
-----------------------------------------------------
Name | DR. CYNTHIA BROWN STEVENS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 307-332-2417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 7534A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------