Provider Demographics
NPI:1871874982
Name:STEVENSON, RUBY VIRGINIA (TEACHER)
Entity type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:VIRGINIA
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71767 BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-8708
Mailing Address - Country:US
Mailing Address - Phone:970-240-1992
Mailing Address - Fax:
Practice Address - Street 1:71767 BUCKHORN RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-8708
Practice Address - Country:US
Practice Address - Phone:970-240-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0408011174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator