Provider Demographics
NPI:1598729766
Name:STEVENS, LINDA L (CNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 SW CENTER ST
Mailing Address - Street 2:APT 4
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6353
Mailing Address - Country:US
Mailing Address - Phone:503-639-2636
Mailing Address - Fax:
Practice Address - Street 1:9210 SW CENTER ST
Practice Address - Street 2:APT 4
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6353
Practice Address - Country:US
Practice Address - Phone:503-639-2636
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2005105118CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide