Provider Demographics
NPI:1649265869
Name:STEVENSON, JANIS FARQUHAR (ACNP)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:FARQUHAR
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:ACNP
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 5635
Mailing Address - Street 2:ATTN: MARIA MITCHELL
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-5635
Mailing Address - Country:US
Mailing Address - Phone:812-337-5003
Mailing Address - Fax:812-337-5010
Practice Address - Street 1:2920 MCINTYRE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4221
Practice Address - Country:US
Practice Address - Phone:812-333-7246
Practice Address - Fax:812-333-4471
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001894A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000368846OtherPMC ANTHEM
IN0000000368824OtherCSC ANTHEM
IN547260TMedicare ID - Type UnspecifiedPAIN MANAGEMENT CENTER
IN000000368846OtherPMC ANTHEM
IN197850IMedicare ID - Type UnspecifiedCOMP SPINE CARE