Provider Demographics
NPI:1679740237
Name:STEPHENSON, DONALD B (RN)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 W CACTUS RD # 104-242
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5200
Mailing Address - Country:US
Mailing Address - Phone:602-330-1737
Mailing Address - Fax:
Practice Address - Street 1:10845 N 99TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-2406
Practice Address - Country:US
Practice Address - Phone:623-444-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37832164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse