Provider Demographics
NPI:1508359472
Name:STEVENSON, EMILY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2453
Mailing Address - Country:US
Mailing Address - Phone:714-401-7606
Mailing Address - Fax:
Practice Address - Street 1:28250 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1659
Practice Address - Country:US
Practice Address - Phone:714-401-7606
Practice Address - Fax:248-385-5722
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17100017176B00000X
MI7601000006176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife