Provider Demographics
NPI:1770199481
Name:NORTHERN, STEVEN CLEO JR (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CLEO
Last Name:NORTHERN
Suffix:JR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 W GREENWAY RD STE 124
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3308
Mailing Address - Country:US
Mailing Address - Phone:480-600-1037
Mailing Address - Fax:
Practice Address - Street 1:5820 W GREENWAY RD STE 124
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3308
Practice Address - Country:US
Practice Address - Phone:602-622-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF05200335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily