Provider Demographics
NPI:1912749193
Name:STEVENSON, LAWRENCE II
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:STEVENSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3844 DALE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-9108
Mailing Address - Country:US
Mailing Address - Phone:989-408-5654
Mailing Address - Fax:
Practice Address - Street 1:3844 DALE RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-9108
Practice Address - Country:US
Practice Address - Phone:989-408-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider