Provider Demographics
NPI:1740585272
Name:STEVENS, LORRAINE (PA)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13945 W GRAND AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2437
Mailing Address - Country:US
Mailing Address - Phone:623-546-0007
Mailing Address - Fax:623-584-6915
Practice Address - Street 1:13945 W GRAND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2437
Practice Address - Country:US
Practice Address - Phone:623-546-0007
Practice Address - Fax:623-584-6915
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4781363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical