Provider Demographics
NPI:1871798983
Name:STEVENS, THERESA M (MSN RN APN C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSN RN APN C
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Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:3205 FIRE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5857
Practice Address - Country:US
Practice Address - Phone:609-407-1220
Practice Address - Fax:609-407-7149
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2023-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NN10505700363L00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q10224Medicare UPIN
077130AUBMedicare ID - Type Unspecified