Provider Demographics
NPI:1275221178
Name:STEVENSON, DONITA
Entity Type:Individual
Prefix:
First Name:DONITA
Middle Name:
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 1:1799 MOUNT MARIAH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-1501
Mailing Address - Country:US
Mailing Address - Phone:702-563-4660
Mailing Address - Fax:702-319-6147
Practice Address - Street 1:1799 MOUNT MARIAH DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1501
Practice Address - Country:US
Practice Address - Phone:702-563-4660
Practice Address - Fax:702-319-6147
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5392172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker