| NPI | 1629008495 |
|---|---|
| Former Name | MARY SANDRA STEVENS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 16628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 42930) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2017-01-30 |