Provider Demographics
NPI:1851927958
Name:STEVENS, JENICE
Entity Type:Individual
Prefix:
First Name:JENICE
Middle Name:
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 1:205 N LEE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:76878
Mailing Address - Country:US
Mailing Address - Phone:970-799-2681
Mailing Address - Fax:
Practice Address - Street 1:205 N LEE
Practice Address - Street 2:
Practice Address - City:SANTA ANNA
Practice Address - State:TX
Practice Address - Zip Code:76878
Practice Address - Country:US
Practice Address - Phone:970-799-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX983259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse