Provider Demographics
NPI:1447344650
Name:STEVENS, DOUGLAS FRANK (MS,RN,CWOCN)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:FRANK
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MS,RN,CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 LAUREL AVE
Mailing Address - Street 2:APT. #1
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7488
Mailing Address - Country:US
Mailing Address - Phone:651-646-1173
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR099903-0163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy