Provider Demographics
NPI:1649948464
Name:STEVENS, CARMELLA
Entity type:Individual
Prefix:
First Name:CARMELLA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
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 461802
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80046-1802
Mailing Address - Country:US
Mailing Address - Phone:720-232-1649
Mailing Address - Fax:303-997-4589
Practice Address - Street 1:21046 E CRESTLINE PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3624
Practice Address - Country:US
Practice Address - Phone:720-232-1649
Practice Address - Fax:303-997-4589
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)