Basic Information
| Provider Information | |||||||||
| NPI: | 1871589069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | LAUREL | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 VISTA DEL OCASO RD | ||||||||
| Address2: | |||||||||
| City: | RANCHOS DE TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057379608 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 SPRUCE ST | ||||||||
| Address2: | ESPANOLA HOSPITAL | ||||||||
| City: | ESPANOLA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057537111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LF0000X | R42934 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.