Provider Demographics
NPI:1629111232
Name:STEVENSON, DAVID M (APRN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CELLINI PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1666
Mailing Address - Country:US
Mailing Address - Phone:203-932-6481
Mailing Address - Fax:203-932-4051
Practice Address - Street 1:74 CHESHIRE ROAD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-0649
Practice Address - Country:US
Practice Address - Phone:203-932-2370
Practice Address - Fax:203-626-5622
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT2031363LA2200X
CT002031363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP13127Medicare UPIN