Provider Demographics
NPI:1487628400
Name:STEVENSON, DANA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:COWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3075 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1505
Mailing Address - Country:US
Mailing Address - Phone:615-772-8985
Mailing Address - Fax:
Practice Address - Street 1:3075 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1505
Practice Address - Country:US
Practice Address - Phone:615-772-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA10504367500000X
KY6062A367500000X
TN11865367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4120865OtherBCBS
TN3636325Medicare PIN