Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW171 | FL |
NPI | 1053457739 |
---|---|
Provider Name | Jessica Leigh Stevenson |
First Address | Gainesville, FL 32601-5261 |
Second Address | Gainesville, FL 32609-2944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 19/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014378000 | (05) | FL |