Provider Demographics
NPI:1538039771
Name:STEPHENSON, CHRISTINA OLIVIA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:OLIVIA
Last Name:STEPHENSON
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 1:1501 W BRADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61625-0001
Mailing Address - Country:US
Mailing Address - Phone:336-848-1984
Mailing Address - Fax:
Practice Address - Street 1:1501 W BRADLEY AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61625-0001
Practice Address - Country:US
Practice Address - Phone:336-848-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program