Provider Demographics
NPI:1710286489
Name:STEVENS, JAIME (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 QUEEN ST APT 2707
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4146
Mailing Address - Country:US
Mailing Address - Phone:860-919-2314
Mailing Address - Fax:
Practice Address - Street 1:1177 QUEEN ST APT 2707
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4146
Practice Address - Country:US
Practice Address - Phone:860-919-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00776602084P0800X
FLME1324952084P0804X
AK1538092084P0804X
WAMD607513102084P0804X
390200000X
HI186732084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program