Healthcare Provider Details

I. General information

NPI: 1386139053
Provider Name (Legal Business Name): MICHELLE STEPHENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE BRYANT

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 S GOVERNORS AVE STE B100
DOVER DE
19904-6930
US

IV. Provider business mailing address

4923 OGLETOWN STANTON RD STE 200
NEWARK DE
19713-2081
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-3227
  • Fax:
Mailing address:
  • Phone: 302-225-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0040594
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: