Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95008459 | CA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP61041968 | WA |
NPI | 1023566825 |
---|---|
Provider Name | Deva Stevens |
First Address | Culver City, CA 90232-2732 |
Second Address | Culver City, CA 90232-2732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2016 |
Last Update Date | 21/04/2020 |