Healthcare Provider Details

I. General information

NPI: 1639329063
Provider Name (Legal Business Name): MISTY SUZETTE STEFFEN CNM, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY SUZETTE HARSH RN, FNP, CNM, PMHNP

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 S BASCOM AVE STE 100
CAMPBELL CA
95008-5541
US

IV. Provider business mailing address

981 KATHERINE CT
SAN JOSE CA
95126-1622
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax:
Mailing address:
  • Phone: 831-295-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number507188
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19470
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW1058
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: