Provider Demographics
NPI:1902143241
Name:STEVENS, NATHAN LEE (RN)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:LEE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11439 GALLIA PIKE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-7903
Mailing Address - Country:US
Mailing Address - Phone:740-981-6795
Mailing Address - Fax:
Practice Address - Street 1:2159 DOGWOOD RIDGE RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-9044
Practice Address - Country:US
Practice Address - Phone:740-574-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.360958163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse