Provider Demographics
NPI:1881082485
Name:STEVENS, EUDINE (CPM)
Entity type:Individual
Prefix:
First Name:EUDINE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:CONDE
Mailing Address - State:SD
Mailing Address - Zip Code:57434-0063
Mailing Address - Country:US
Mailing Address - Phone:406-939-1960
Mailing Address - Fax:877-922-7925
Practice Address - Street 1:550 BROADWAY ST NW
Practice Address - Street 2:
Practice Address - City:CONDE
Practice Address - State:SD
Practice Address - Zip Code:57434-2017
Practice Address - Country:US
Practice Address - Phone:406-939-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60568305176B00000X
SD002102176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife