Provider Demographics
NPI:1366610107
Name:STEVENS, PATRICIA FREEMAN (RN, MS, NNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FREEMAN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RN, MS, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1801
Mailing Address - Country:US
Mailing Address - Phone:708-937-9811
Mailing Address - Fax:
Practice Address - Street 1:316 N PARK RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1801
Practice Address - Country:US
Practice Address - Phone:708-937-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007914363LN0000X
CA6514363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal