| Doctor Name: | NICOLE LYNN STEVENSON |
| NPI Number: | 1063727204 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN-NPC |
| License Number: | 71003367A |
| Business Practice Address: | 1003 E Illinois St Petersburg, IN - 475678068 |
| Business Phone Number: | 8123543485 |
| Business Fax Number: | 8123543459 |
| Mailing Address: | Po Box 1028, JASPER |
| State: | IN |
| Postal Code: | 475471028 |
| Phone Number: | 8129965255 |
| Fax Number: | 8129968497 |
| NPI Enumeration Date: | 08/12/2010 |
| NPI Last Update Date: | 10/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71003367A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |