Provider Demographics
NPI:1720686934
Name:STEVENS, LEDENA SUE
Entity Type:Individual
Prefix:
First Name:LEDENA
Middle Name:SUE
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 1:5342 MCCLELLAN HWY
Mailing Address - Street 2:
Mailing Address - City:BRANCHLAND
Mailing Address - State:WV
Mailing Address - Zip Code:25506-8725
Mailing Address - Country:US
Mailing Address - Phone:304-840-3560
Mailing Address - Fax:
Practice Address - Street 1:5342 MCCLELLAN HWY
Practice Address - Street 2:
Practice Address - City:BRANCHLAND
Practice Address - State:WV
Practice Address - Zip Code:25506-8725
Practice Address - Country:US
Practice Address - Phone:304-840-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant