Provider Demographics
NPI:1912225160
Name:STEVENS, LAUREL (MD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SOUTHPOINT LN
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4175
Mailing Address - Country:US
Mailing Address - Phone:509-525-3720
Mailing Address - Fax:509-525-4691
Practice Address - Street 1:19 SOUTHPOINT LN
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4175
Practice Address - Country:US
Practice Address - Phone:509-525-3720
Practice Address - Fax:509-525-4691
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61083925207N00000X
CA131351207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty