Provider Demographics
NPI:1801228903
Name:STEIN, AVIS L (RN)
Entity Type:Individual
Prefix:
First Name:AVIS
Middle Name:L
Last Name:STEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2141
Mailing Address - Country:US
Mailing Address - Phone:509-768-3826
Mailing Address - Fax:
Practice Address - Street 1:3511 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2141
Practice Address - Country:US
Practice Address - Phone:509-768-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201242809RN163WM0705X
NMTL-02314163WS0200X
WARN00122648163WX0003X
IDN-26310163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient