Provider Demographics
NPI:1427755123
Name:STEVENS, NEDRA
Entity type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:STEVENS
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 1:13 MILL ST
Mailing Address - Street 2:
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-9401
Mailing Address - Country:US
Mailing Address - Phone:585-468-2900
Mailing Address - Fax:585-468-5079
Practice Address - Street 1:13 MILL ST
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-9401
Practice Address - Country:US
Practice Address - Phone:585-468-2900
Practice Address - Fax:585-468-5079
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY515721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse