Provider Demographics
NPI:1700204377
Name:STEVEN, MARY JO (MS, RN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:STEVEN
Suffix:
Gender:F
Credentials:MS, RN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7094 GREY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-8504
Mailing Address - Country:US
Mailing Address - Phone:734-807-0055
Mailing Address - Fax:
Practice Address - Street 1:2751 BAY PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4921
Practice Address - Country:US
Practice Address - Phone:419-690-7670
Practice Address - Fax:419-697-6877
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260758282N00000X, 363LA2200X
OH020723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP38150027Medicare PIN