Provider Demographics
NPI:1427755347
Name:STEVENSON, KATINA DENISE
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:DENISE
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 1:13 16TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1502
Mailing Address - Country:US
Mailing Address - Phone:202-403-4805
Mailing Address - Fax:
Practice Address - Street 1:13 16TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1502
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5184258OtherID
DC5184258OtherIDENTIFICATION