Provider Demographics
NPI:1437988557
Name:STEVENSON, DOMIA KIMBERLY
Entity type:Individual
Prefix:
First Name:DOMIA
Middle Name:KIMBERLY
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MISSOURI AVE NW APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1827
Mailing Address - Country:US
Mailing Address - Phone:202-869-6183
Mailing Address - Fax:
Practice Address - Street 1:1365 KENNEDY ST NW APT 206
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3567
Practice Address - Country:US
Practice Address - Phone:202-869-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant