Provider Demographics
NPI:1093515660
Name:STEVENS, MARA JACQUELINE
Entity type:Individual
Prefix:MS
First Name:MARA
Middle Name:JACQUELINE
Last Name:STEVENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 KEEFER RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1460
Mailing Address - Country:US
Mailing Address - Phone:330-951-2572
Mailing Address - Fax:
Practice Address - Street 1:1422 KEEFER RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1460
Practice Address - Country:US
Practice Address - Phone:330-951-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider