Provider Demographics
NPI:1871349365
Name:STEVENS, TERRENCE A
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5952 GLEANER HALL RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9634
Mailing Address - Country:US
Mailing Address - Phone:231-313-2213
Mailing Address - Fax:
Practice Address - Street 1:5952 GLEANER HALL RD
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9634
Practice Address - Country:US
Practice Address - Phone:231-313-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker