Provider Demographics
NPI:1932788742
Name:STEPHENS, IZILLE BRENDA
Entity Type:Individual
Prefix:
First Name:IZILLE
Middle Name:BRENDA
Last Name:STEPHENS
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 1:546 E 83RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3115
Mailing Address - Country:US
Mailing Address - Phone:917-588-5927
Mailing Address - Fax:
Practice Address - Street 1:546 E 83RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3115
Practice Address - Country:US
Practice Address - Phone:917-588-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4220673163WC0400X
NY426206-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WC0400XNursing Service ProvidersRegistered NurseCase Management