Provider Demographics
NPI:1285331181
Name:STEVENSON, AMIRA SOMONE
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:SOMONE
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 1:3712 GARFIELD ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1372
Mailing Address - Country:US
Mailing Address - Phone:202-403-4805
Mailing Address - Fax:
Practice Address - Street 1:3712 GARFIELD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-1372
Practice Address - Country:US
Practice Address - Phone:202-403-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC51844312470A2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5184431Medicaid
DC5184431OtherIDENTIFICATION