Provider Demographics
NPI:1063609600
Name:STEVENS, DENISE MARSHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARSHELLE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 NE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3546
Mailing Address - Country:US
Mailing Address - Phone:541-659-2844
Mailing Address - Fax:
Practice Address - Street 1:1661 NE TERRACE DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3546
Practice Address - Country:US
Practice Address - Phone:541-659-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0950030164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse