Provider Demographics
NPI:1497359186
Name:STEVENS, BRENDA SUE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-1129
Mailing Address - Country:US
Mailing Address - Phone:567-454-9691
Mailing Address - Fax:
Practice Address - Street 1:107 MAPLEWOOD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1129
Practice Address - Country:US
Practice Address - Phone:567-454-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker