Provider Demographics
NPI:1275766404
Name:STEVENS, GLORIA JEAN
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:STEVENS
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 1:21051 27 MILE RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:MI
Mailing Address - Zip Code:48096-3700
Mailing Address - Country:US
Mailing Address - Phone:586-749-8808
Mailing Address - Fax:586-749-7409
Practice Address - Street 1:21051 27 MILE RD
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:MI
Practice Address - Zip Code:48096-3700
Practice Address - Country:US
Practice Address - Phone:586-749-8808
Practice Address - Fax:586-749-7409
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging