Provider Demographics
NPI:1104542018
Name:STEVENS, MINDI LYNNE
Entity type:Individual
Prefix:MS
First Name:MINDI
Middle Name:LYNNE
Last Name:STEVENS
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 1:511 BURROUGHS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3389
Mailing Address - Country:US
Mailing Address - Phone:304-285-5500
Mailing Address - Fax:304-285-2787
Practice Address - Street 1:511 BURROUGHS ST STE 101
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3389
Practice Address - Country:US
Practice Address - Phone:304-285-5500
Practice Address - Fax:304-285-2787
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide