Individual
NICOLE L STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN-NPC
Contact information
Practice address
1003 E ILLINOIS ST, PETERSBURG, IN 47567-8068
(812) 354-3485
(812) 354-3459
Mailing address
PO BOX 1028, JASPER, IN 47547-1028
(812) 996-5255
(812) 996-8497
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71003367A
IN
363LF0000X
Family Nurse Practitioner
Primary
71003367A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200996500
—
IN
01
—
28164932A
INDIANA STATE LICENSE
IN
05
—
7100275180
—
KY
Enumeration date
08/12/2010
Last updated
06/28/2017
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