Provider Demographics
NPI:1215587035
Name:STEBBINS, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STEBBINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W724 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151
Mailing Address - Country:US
Mailing Address - Phone:715-589-4499
Mailing Address - Fax:
Practice Address - Street 1:724 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151
Practice Address - Country:US
Practice Address - Phone:715-589-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider