Provider Demographics
NPI:1134542343
Name:STEVENS, MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 SUNDOWN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-8843
Mailing Address - Country:US
Mailing Address - Phone:231-239-6101
Mailing Address - Fax:231-251-8267
Practice Address - Street 1:2870 E GRAND BLVD
Practice Address - Street 2:STE 600 PMB 1042
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:231-239-6101
Practice Address - Fax:231-251-8267
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2025-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012176364SP0808X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health