1326302845 NPI number — EMILY JEANETTE STEVENSON

Table of content: EMILY JEANETTE STEVENSON (NPI 1326302845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326302845 NPI number — EMILY JEANETTE STEVENSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENSON
Provider First Name:
EMILY
Provider Middle Name:
JEANETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWKER
Provider Other First Name:
EMILY
Provider Other Middle Name:
JEANETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326302845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 EDGEVIEW DR APT 4316
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80021-8089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-202-2710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 E CHERRY CREEK SOUTH DR STE 710
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80246-1534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-432-8487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)