Provider Demographics
NPI:1245575984
Name:STEVENS, MARY PATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:STEVENS
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 1:1700 MALL DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3849
Mailing Address - Country:US
Mailing Address - Phone:218-727-0990
Mailing Address - Fax:218-727-1179
Practice Address - Street 1:1700 MALL DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3849
Practice Address - Country:US
Practice Address - Phone:218-727-0990
Practice Address - Fax:218-727-1179
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR122590-7163W00000X
WI110340-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse