Provider Demographics
NPI:1245087501
Name:STEVENS, COLLEEN (APRN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 1325 N STE 150
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8179
Mailing Address - Country:US
Mailing Address - Phone:435-263-0267
Mailing Address - Fax:435-867-1472
Practice Address - Street 1:1251 NORTHFIELD RD STE 150
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8622
Practice Address - Country:US
Practice Address - Phone:435-263-0267
Practice Address - Fax:435-867-1472
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT281040-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner