Provider Demographics
NPI:1275518185
Name:STEVENS, MARGO V (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:V
Last Name:STEVENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 G ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3109
Mailing Address - Country:US
Mailing Address - Phone:801-355-7582
Mailing Address - Fax:
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-3176
Practice Address - Country:US
Practice Address - Phone:801-539-7000
Practice Address - Fax:801-539-7050
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT209808-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT638896OtherDESERET MUTUAL
UT942938348005OtherCHAMPUS
UT107002816101OtherINTERMOUNTAIN HEALTH CARE
UT500030249OtherRCAR- RAILROAD MEDICARE
UT942938348MGOOtherEDUCATORS MUTUAL
UT500030249OtherRCAR- RAILROAD MEDICARE
UT942938348005OtherCHAMPUS