Provider Demographics
NPI:1831539733
Name:STEVENS, ALTA MAY (CNA/HHA)
Entity type:Individual
Prefix:MS
First Name:ALTA
Middle Name:MAY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CNA/HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-9775
Mailing Address - Country:US
Mailing Address - Phone:601-896-5361
Mailing Address - Fax:
Practice Address - Street 1:6522 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-9775
Practice Address - Country:US
Practice Address - Phone:601-896-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker