Basic Information
| Provider Information | |||||||||
| NPI: | 1124455035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | JONI | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 BARNES AVE | ||||||||
| Address2: | |||||||||
| City: | LA JUNTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193845446 | ||||||||
| FaxNumber: | 7193845672 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 S 12TH STREET | ||||||||
| Address2: | |||||||||
| City: | ROCKY FORD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192547623 | ||||||||
| FaxNumber: | 7192545112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2013 | ||||||||
| LastUpdateDate: | 10/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.