Provider Demographics
NPI:1487186979
Name:STEVENS, SEAN (LPN)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 WOODS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WALHONDING
Mailing Address - State:OH
Mailing Address - Zip Code:43843-9606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4020 WOODS CHURCH RD
Practice Address - Street 2:
Practice Address - City:WALHONDING
Practice Address - State:OH
Practice Address - Zip Code:43843-9606
Practice Address - Country:US
Practice Address - Phone:305-849-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.137106.M.IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse