Provider Demographics
NPI:1962162420
Name:STEVENS, ELIZABETH L
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:STEVENS
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 1:1539 SE NIGHT HERON WAY
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-3920
Mailing Address - Country:US
Mailing Address - Phone:760-622-7564
Mailing Address - Fax:
Practice Address - Street 1:1539 SE NIGHT HERON WAY
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-3920
Practice Address - Country:US
Practice Address - Phone:760-622-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula