Provider Demographics
NPI:1497857825
Name:STEVENS, DIANE M (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 AVELON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4569
Mailing Address - Country:US
Mailing Address - Phone:207-322-5266
Mailing Address - Fax:
Practice Address - Street 1:5809 AVELON VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4569
Practice Address - Country:US
Practice Address - Phone:207-322-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011286363LF0000X
NC341899163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP4500Medicare ID - Type Unspecified
Q11753Medicare UPIN