Provider Demographics
NPI:1215997655
Name:STEVENSON, NANCY J (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:STEVENSON
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 1:4000 S 700 E
Mailing Address - Street 2:STE 10
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2180
Mailing Address - Country:US
Mailing Address - Phone:801-268-4141
Mailing Address - Fax:801-261-8609
Practice Address - Street 1:4000 S 700 E
Practice Address - Street 2:STE 10
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84107-2180
Practice Address - Country:US
Practice Address - Phone:801-268-4141
Practice Address - Fax:801-261-8609
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT214067-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP31110Medicare UPIN