Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 105891 | CO |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP008074 | PA |
NPI | 1194855924 |
---|---|
Provider Name | Wendy Jean Stevens |
First Address | Durango, CO 81301-4998 |
Second Address | Cortez, CO 81321-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 22/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q62519 | (02) | CO |