Provider Demographics
NPI:1225464555
Name:STEVENSON, BETH (NP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LAFAYETTE AVE SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4693
Mailing Address - Country:US
Mailing Address - Phone:616-685-6900
Mailing Address - Fax:616-685-8950
Practice Address - Street 1:310 LAFAYETTE AVE SE
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-685-6900
Practice Address - Fax:616-685-8950
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily