MEDICARE: MELINDA KAE STEVENSON RN

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	163W00000X	Registered Nurse	R044123	ME

General Provider Information

NPI Number	:	1922367697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA KAE STEVENSON RN

Provider Business Mailing Address
First Line	:	1171 RIVER RD
Second Line	:
City	:	BOWDOINHAM
State	:	ME
Zip	:	04008-5604
Country	:	US
Telephone Number	:	207-632-7113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 RIVER RD
Second Line	:
City	:	BOWDOINHAM
State	:	ME
Zip	:	04008-5604
Country	:	US
Telephone Number	:	207-632-7113
Fax Number	:

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

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	05/15/2012

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