Provider Demographics
NPI:1962778498
Name:STEVENS, MARIE ANNE (LICENSED PRACTICAL N)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2679 WEST SENECA TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108
Mailing Address - Country:US
Mailing Address - Phone:315-673-2999
Mailing Address - Fax:
Practice Address - Street 1:4057 SENECA TPK
Practice Address - Street 2:VAN DUYN HOME AND HOSPITAL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-435-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130442-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse