Provider Demographics
NPI:1962439679
Name:STEPHENS, EVA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:VANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:906 ASPEN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2512
Mailing Address - Country:US
Mailing Address - Phone:202-806-5601
Mailing Address - Fax:
Practice Address - Street 1:1251B SARATOGA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1025
Practice Address - Country:US
Practice Address - Phone:202-832-8818
Practice Address - Fax:202-832-8575
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256765363LF0000X
MDR103027363LF0000X
DCRN53673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034885400Medicaid