Basic Information
| Provider Information | |||||||||
| NPI: | 1962778498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICENSED PRACTICAL N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2679 WEST SENECA TURNPIKE | ||||||||
| Address2: | |||||||||
| City: | MARCELLUS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156732999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4057 SENECA TPK | ||||||||
| Address2: | VAN DUYN HOME AND HOSPITAL | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154355511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2012 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 130442-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.