Provider Demographics
NPI:1417200239
Name:STEVENSON, JILL MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SPRINGSIDE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4530
Mailing Address - Country:US
Mailing Address - Phone:330-666-9544
Mailing Address - Fax:330-670-8569
Practice Address - Street 1:266 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-3952
Practice Address - Country:US
Practice Address - Phone:419-307-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21773363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health