Provider Demographics
NPI:1023724432
Name:STEVENS, SHIRLEY IRENE
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:IRENE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHIRLEY
Other - Middle Name:I
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13820 18TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:ND
Mailing Address - Zip Code:58064-9745
Mailing Address - Country:US
Mailing Address - Phone:701-238-5425
Mailing Address - Fax:
Practice Address - Street 1:13820 18TH ST SE
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:ND
Practice Address - Zip Code:58064-9745
Practice Address - Country:US
Practice Address - Phone:701-238-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle