Provider Demographics
NPI:1912618919
Name:STEVENTON, ALLISON FAYE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:FAYE
Last Name:STEVENTON
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 1:47617 VISTAS CIRCLE DR N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1484
Mailing Address - Country:US
Mailing Address - Phone:734-751-3777
Mailing Address - Fax:
Practice Address - Street 1:5900 N LOTZ RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4331
Practice Address - Country:US
Practice Address - Phone:734-394-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703104528164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse