Provider Demographics
NPI:1407860422
Name:STEVENS, SHANA (MD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N. KANSAS
Mailing Address - Street 2:WCGME
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-8175
Mailing Address - Country:US
Mailing Address - Phone:316-962-3030
Mailing Address - Fax:
Practice Address - Street 1:1010 N. KANSAS
Practice Address - Street 2:WCGME
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-8175
Practice Address - Country:US
Practice Address - Phone:316-962-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine