Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD16456 | ME |
NPI | 1043236904 |
---|---|
Provider Name | Sandra L Stevens |
First Address | Portland, ME 04102-3175 |
Second Address | Portland, ME 04102-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I09750 | (02) | ME |