Provider Demographics
NPI:1467145243
Name:STEVENSON, JAMIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 TOWNE CENTRE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2833
Mailing Address - Country:US
Mailing Address - Phone:989-792-2792
Mailing Address - Fax:
Practice Address - Street 1:4701 TOWNE CENTRE RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2834
Practice Address - Country:US
Practice Address - Phone:989-792-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID41122147363LF0000X
MI4704312229363LF0000X
MI4704312229NSA230F9363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily