Provider Demographics
NPI:1487081402
Name:STEVENS, JADE (LPN)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WINDSORSHIRE DR
Mailing Address - Street 2:C
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1229
Mailing Address - Country:US
Mailing Address - Phone:585-354-3502
Mailing Address - Fax:
Practice Address - Street 1:118 WINDSORSHIRE DR
Practice Address - Street 2:C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1229
Practice Address - Country:US
Practice Address - Phone:585-354-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse