Individual
JACQUELINE M. STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-2297
(260) 434-6420
Mailing address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-6339
(260) 434-6389
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001809
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000345345
ANTHEM
IN
05
—
200250820
—
IN
Enumeration date
03/23/2006
Last updated
10/09/2014
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