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NPI Code Detail

MEDICARE: ANDREA NICOLE STEVENS FNP

MEDICARE: ANDREA NICOLE STEVENS FNP
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
1363L00000XNurse Practitioner63151ID

General Provider Information

NPI Number : 1992341150
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA NICOLE STEVENS FNP
Provider Business Mailing Address
First Line : PO BOX 191050
Second Line :
City : BOISE
State : ID
Zip : 83719-1050
Country : US
Telephone Number : 208-955-6500
Fax Number :
Provider Business Practice Location Address
First Line : 1115 12TH AVE RD
Second Line :
City : NAMPA
State : ID
Zip : 83686-5738
Country : US
Telephone Number : 208-498-1080
Fax Number : 208-498-1080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2019
Last Update Date : 01/29/2020

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Directions to “ ANDREA NICOLE STEVENS FNP” Practice Location

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