MEDICARE: JAMIE STEVENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN288962	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184073728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE STEVENS

Provider Business Mailing Address
First Line	:	50 E WYLIE AVE
Second Line	:	SUITE 2 AND 3
City	:	WASHINGTON
State	:	PA
Zip	:	15301-2059
Country	:	US
Telephone Number	:	724-222-6220
Fax Number	:	724-222-6221

Provider Business Practice Location Address
First Line	:	50 E WYLIE AVE
Second Line	:	SUITE 2 AND 3
City	:	WASHINGTON
State	:	PA
Zip	:	15301-2059
Country	:	US
Telephone Number	:	724-222-6220
Fax Number	:	724-222-6221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2016
Last Update Date	:	06/05/2016

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Directions to “ JAMIE STEVENS ” Practice Location

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