Provider Demographics
NPI:1558416909
Name:STEVENS, MONICA C (NH-CM)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:F
Credentials:NH-CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 TRASK RD
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-6511
Mailing Address - Country:US
Mailing Address - Phone:603-237-8686
Mailing Address - Fax:603-237-8686
Practice Address - Street 1:84 TRASK RD
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-6511
Practice Address - Country:US
Practice Address - Phone:603-237-8686
Practice Address - Fax:603-237-8686
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1017176B00000X
VT107-0000039176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30462100Medicaid