Provider Demographics
NPI:1740713502
Name:STEVENS, VERONICA STEVENS (ND)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:STEVENS
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:STEVENS JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:13125 CONDUCTOR WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6820
Mailing Address - Country:US
Mailing Address - Phone:202-641-4336
Mailing Address - Fax:
Practice Address - Street 1:3 BETHESDA METRO CTR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5330
Practice Address - Country:US
Practice Address - Phone:202-641-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP-0036405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional