Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | ||
Y | 156FX1700X | Ocularist |
NPI | 1447915913 |
---|---|
Provider Name | Tynyetta T Stevenson |
First Address | Millville, NJ 08332-6021 |
Second Address | Millville, NJ 08332-6021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2021 |
Last Update Date | 01/11/2021 |