Provider Demographics
NPI:1316189004
Name:STEVENS, BETHANNE (ARNP, FNP-C)
Entity type:Individual
Prefix:MS
First Name:BETHANNE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3866
Mailing Address - Country:US
Mailing Address - Phone:641-455-5200
Mailing Address - Fax:641-455-5150
Practice Address - Street 1:920 N QUINCY AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3866
Practice Address - Country:US
Practice Address - Phone:641-455-5200
Practice Address - Fax:641-455-5150
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-104852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA104852OtherIOWA LICENSE
IA1316189004Medicaid