Provider Demographics
NPI:1245745157
Name:STEPHENS, NICHOLAS GENE (LPN)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:GENE
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-5208
Mailing Address - Country:US
Mailing Address - Phone:320-224-3100
Mailing Address - Fax:
Practice Address - Street 1:400 ANNANDALE BLVD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302-3141
Practice Address - Country:US
Practice Address - Phone:651-259-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN710329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse