Provider Demographics
NPI:1750533519
Name:STEVENSON, DWAN S
Entity type:Individual
Prefix:MRS
First Name:DWAN
Middle Name:S
Last Name:STEVENSON
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 1:905 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-2215
Mailing Address - Country:US
Mailing Address - Phone:504-362-0376
Mailing Address - Fax:504-365-0878
Practice Address - Street 1:905 MONROE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2215
Practice Address - Country:US
Practice Address - Phone:504-362-0376
Practice Address - Fax:504-365-0878
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA87393747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant