Provider Demographics
NPI:1528676848
Name:STEVENS, JAY C (LPN)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W SMILEY AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1004
Mailing Address - Country:US
Mailing Address - Phone:419-631-6957
Mailing Address - Fax:
Practice Address - Street 1:55 W SMILEY AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1004
Practice Address - Country:US
Practice Address - Phone:419-631-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.163460.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse