Provider Demographics
NPI:1578008165
Name:STEVENS, AMY G (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W FLAMINGO RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3924
Mailing Address - Country:US
Mailing Address - Phone:702-822-5000
Mailing Address - Fax:702-822-5001
Practice Address - Street 1:4100 W FLAMINGO RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3924
Practice Address - Country:US
Practice Address - Phone:702-822-5000
Practice Address - Fax:702-822-5001
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39155-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered