Stevens, Jacqueline M.
Stevens, Jacqueline M. is an individual health care provider with primary practice located at 7916 W Jefferson Blvd , Fort Wayne IN 46804-4140. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Stevens, Jacqueline M. can be contacted via phone (260) 432-2297.Contact Information
Primary practice address
7916 W Jefferson Blvd
Fort Wayne IN 46804-4140
Phone: (260) 432-2297
Fax: (260) 434-6420
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 71001809 | Indiana |
Profile Details
| NPI number | 1265492599 |
|---|---|
| LBN Legal business name | Stevens, Jacqueline M. |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 23rd, 2006 |
| Last updated | Oct 9th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265492599 | NPPES |
| Indiana | MEDICAID | 200250820 | |
| Indiana | Other | 000000345345 |
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