Provider Demographics
NPI:1003055799
Name:STEVENS, NICK B (AA)
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:B
Last Name:STEVENS
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6283 CHESTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1726
Mailing Address - Country:US
Mailing Address - Phone:775-223-9040
Mailing Address - Fax:
Practice Address - Street 1:741 RANCHO VIA DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-4051
Practice Address - Country:US
Practice Address - Phone:775-223-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness