Provider Demographics
NPI:1235783036
Name:STEVENSON, JENNIFER LASHAWN (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LASHAWN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0032
Mailing Address - Country:US
Mailing Address - Phone:678-896-8190
Mailing Address - Fax:
Practice Address - Street 1:1071 HIGHWAY 16 WEST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223
Practice Address - Country:US
Practice Address - Phone:770-229-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN274720163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse