Provider Demographics
NPI:1437116639
Name:STEVENSON, LAURA KATHLEEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KATHLEEN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25775 MCBEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3708
Mailing Address - Country:US
Mailing Address - Phone:661-254-7200
Mailing Address - Fax:661-254-8204
Practice Address - Street 1:25775 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3708
Practice Address - Country:US
Practice Address - Phone:661-254-7200
Practice Address - Fax:661-254-8204
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15654A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA15654AMedicare ID - Type UnspecifiedMEDICARE#
CAPA27419Medicare UPIN