Individual
THERESA STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(195) 435-9265
(912) 435-5256
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(195) 435-9265
(912) 435-5256
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN068372
GA
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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