Provider Demographics
NPI:1407107022
Name:STEVENS, PEBBLES LEE (NP)
Entity Type:Individual
Prefix:
First Name:PEBBLES
Middle Name:LEE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PEBBLES
Other - Middle Name:LEE
Other - Last Name:TOMKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 REED RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1565
Mailing Address - Country:US
Mailing Address - Phone:774-201-0915
Mailing Address - Fax:
Practice Address - Street 1:42 J DR
Practice Address - Street 2:2E
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-3900
Practice Address - Country:US
Practice Address - Phone:508-837-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265391363LA2200X
RIAPRN02732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health