Provider Demographics
NPI:1871007146
Name:STEVENS, BENJAMIN ROBERT (FNP-C)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:STEVENS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 FARM CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7932
Mailing Address - Country:US
Mailing Address - Phone:616-644-5560
Mailing Address - Fax:
Practice Address - Street 1:4150 E BELTLINE AVE NE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9316
Practice Address - Country:US
Practice Address - Phone:616-447-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035992363LF0000X
MI4704301140363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily