Provider Demographics
NPI:1689213431
Name:STEVENS, SAMANTHA TABTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TABTHA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 CAMINO AL NORTE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2387
Mailing Address - Country:US
Mailing Address - Phone:702-853-1614
Mailing Address - Fax:
Practice Address - Street 1:5135 CAMINO AL NORTE STE 150
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2388
Practice Address - Country:US
Practice Address - Phone:702-853-1614
Practice Address - Fax:702-853-1615
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker