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General NPI Number Information
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NPI Number | 1508407909
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Entity Type | Individual
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Provider Name | BRENDA STEVENS
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Gender | Female
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 103 MEDICINE WAY RD
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City | PERIDOT
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State | AZ
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Zip | 85542-5000
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Country | US
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Telephone | 928-475-1567
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Fax | 928-475-1571
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Provider Business Mailing Address
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Address Line | 102 MEDICINE WAY RD.
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City | SAN CARLOS
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State | AZ
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Zip | 85542
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Country | US
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Telephone | 928-475-1567
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Fax |
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN128086
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License Number State | AZ
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