Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2017002991 | MO |
NPI | 1235568361 |
---|---|
Provider Name | Valerie Stevenson |
First Address | Wentzville, MO 63385-3085 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 25/03/2017 |