Provider Demographics
NPI:1629065719
Name:STEVENSON, EMMY WARING (RN,MS,CFNP)
Entity Type:Individual
Prefix:MS
First Name:EMMY
Middle Name:WARING
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RN,MS,CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W MAIN ST
Mailing Address - Street 2:NORFOLK COMMUNITY HEALTH CENTER
Mailing Address - City:NORFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:13667
Mailing Address - Country:US
Mailing Address - Phone:315-384-4881
Mailing Address - Fax:315-384-4905
Practice Address - Street 1:35 W MAIN ST
Practice Address - Street 2:C/O NORFOLK COMMUNITY HEALTH CENTER
Practice Address - City:NORFOLK
Practice Address - State:NY
Practice Address - Zip Code:13667-3129
Practice Address - Country:US
Practice Address - Phone:315-384-4881
Practice Address - Fax:315-384-4905
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290186-1163W00000X
NYF330032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR88852Medicare UPIN
NY70089AMedicare ID - Type Unspecified