Individual
MS. DELISA LEVERNE STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1532 E GATES ST, COLUMBUS, OH 43206-3331
(614) 445-6611
Mailing address
1532 E GATES ST, COLUMBUS, OH 43206-3331
(614) 445-6611
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
RJ173583
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RJ173583
DRIVER LICENSE
OH
Enumeration date
01/13/2015
Last updated
01/13/2015
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