Healthcare Provider Details

I. General information

NPI: 1649412859
Provider Name (Legal Business Name): THOMAS MICHAEL STEPHENS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JCT. US HWY 160 & NAVAJO ROUTE 35 - RED MESA
TEEC NOS POS AZ
86514
US

IV. Provider business mailing address

HCR 6100 BOX 30
TEEC NOS POS AZ
86514
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5165
  • Fax: 928-656-5164
Mailing address:
  • Phone: 928-656-5165
  • Fax: 928-656-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR179913
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: