Provider Demographics
NPI:1104670322
Name:STEVENSON, AMI SHAVONNE
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:SHAVONNE
Last Name:STEVENSON
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 1:837 JEANETTE AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1254
Mailing Address - Country:US
Mailing Address - Phone:614-843-1097
Mailing Address - Fax:
Practice Address - Street 1:837 JEANETTE AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1254
Practice Address - Country:US
Practice Address - Phone:614-843-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant