Individual
BRENDA STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 MEDICINE WAY RD, PERIDOT, AZ 85542-5000
(928) 475-1567
(928) 475-1571
Mailing address
102 MEDICINE WAY RD., SAN CARLOS, AZ 85542
(928) 475-1567
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN128086
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN128086
ARIZONA STATE BOARD OF NURSING
AZ
Enumeration date
10/07/2019
Last updated
10/07/2019
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