Provider Demographics
NPI:1730343286
Name:STEVENS, ELLA ELAINNE (RN)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:ELAINNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705
Mailing Address - Country:US
Mailing Address - Phone:559-264-7521
Mailing Address - Fax:805-929-6440
Practice Address - Street 1:2550 W CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705
Practice Address - Country:US
Practice Address - Phone:559-264-7521
Practice Address - Fax:805-929-6440
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470760163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71031FMedicaid
CA551983OtherMEDICARE
CAW1508EOtherMEDICARE
CAFHC71031FMedicaid