Provider Demographics
NPI:1528301033
Name:STEVENSON, ADRIAN DARRELL
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:DARRELL
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17216 BROOKMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3305
Mailing Address - Country:US
Mailing Address - Phone:240-339-1351
Mailing Address - Fax:
Practice Address - Street 1:17216 BROOKMEADOW LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3305
Practice Address - Country:US
Practice Address - Phone:240-339-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP26260164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse