Provider Demographics
NPI:1922367697
Name:STEVENSON, MELINDA KAE (RN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAE
Last Name:STEVENSON
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 1:1171 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOWDOINHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04008-5604
Mailing Address - Country:US
Mailing Address - Phone:207-632-7113
Mailing Address - Fax:
Practice Address - Street 1:1171 RIVER RD
Practice Address - Street 2:
Practice Address - City:BOWDOINHAM
Practice Address - State:ME
Practice Address - Zip Code:04008-5604
Practice Address - Country:US
Practice Address - Phone:207-632-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER044123163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse