Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53456 | KY |
Y | 2080P0214X | Pediatric Pulmonologist | 53456 | KY |
NPI | 1417375197 |
---|---|
Provider Name | Dr. Erica Lynn Stevens |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD461129 | FULL UNRESTRICTED MEDICAL LICENSE (01) | PA |
MT212692 | MEDICAL TRAINING LICENSE (01) | PA |