Provider Demographics
NPI:1770136053
Name:STEVENSON, TAMMY (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5532 S YAKIMA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6538
Mailing Address - Country:US
Mailing Address - Phone:720-839-0427
Mailing Address - Fax:
Practice Address - Street 1:1155 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3632
Practice Address - Country:US
Practice Address - Phone:303-436-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0197115163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)