Provider Demographics
NPI:1659672061
Name:STEVENSON, SHAWNEE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHAWNEE
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61461
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-1461
Mailing Address - Country:US
Mailing Address - Phone:480-227-3029
Mailing Address - Fax:480-968-2515
Practice Address - Street 1:8687 E VIA DE VENTURA
Practice Address - Street 2:SUITE 207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3347
Practice Address - Country:US
Practice Address - Phone:480-609-9000
Practice Address - Fax:480-609-9022
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP046187164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse