Provider Demographics
NPI:1891341442
Name:STEVENSON, CARLA LATRESE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LATRESE
Last Name:STEVENSON
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:PO BOX 311315
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35231-1315
Mailing Address - Country:US
Mailing Address - Phone:205-791-7927
Mailing Address - Fax:
Practice Address - Street 1:1450 FORESTDALE BLVD # 311315
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-3024
Practice Address - Country:US
Practice Address - Phone:205-791-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider