Provider Demographics
NPI:1225797814
Name:STEVENSON, LIESHA L
Entity Type:Individual
Prefix:MS
First Name:LIESHA
Middle Name:L
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2736
Mailing Address - Country:US
Mailing Address - Phone:618-332-9800
Mailing Address - Fax:
Practice Address - Street 1:39 LOUISE LN
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2736
Practice Address - Country:US
Practice Address - Phone:618-332-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA
00000000OtherNON-MEDICAIL HOME SERVICES