Provider Demographics
NPI:1275644577
Name:STEVENSON, LAURIE ELLEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ELLEN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:202 S FOREST DR
Mailing Address - Street 2:APT #3
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7931
Mailing Address - Country:US
Mailing Address - Phone:907-398-9371
Mailing Address - Fax:907-283-4236
Practice Address - Street 1:805 FRONTAGE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7755
Practice Address - Country:US
Practice Address - Phone:907-283-2231
Practice Address - Fax:907-283-4236
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS1410745OtherDEA