1609853035 NPI number — STEPHANIE ANNE NEVINS MD

Table of content: STEPHANIE ANNE NEVINS MD (NPI 1609853035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609853035 NPI number — STEPHANIE ANNE NEVINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEVINS
Provider First Name:
STEPHANIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609853035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22057
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85285-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-820-0627
Provider Business Mailing Address Fax Number:
480-820-4840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-7510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-820-0627
Provider Business Practice Location Address Fax Number:
480-820-4840
Provider Enumeration Date:
12/28/2005

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: 207L00000X , with the licence number:  34159 , 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)

  • Identifier: 962987 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com