Individual
MS. ANTOINETTE SUSAN STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3744 BLUFF PL, SAN PEDRO, CA 90731-7006
(424) 772-1649
Mailing address
3744 BLUFF PL, SAN PEDRO, CA 90731-7006
(424) 772-1649
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
235258
CA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
235258
CA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
235258
CA
Other
Enumeration date
03/21/2013
Last updated
03/21/2013
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