Healthcare Provider Details

I. General information

NPI: 1770449670
Provider Name (Legal Business Name): MICHAEL JOEL STEVENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 5TH AVE SE APT 105
DEVILS LAKE ND
58301-3975
US

IV. Provider business mailing address

1101 5TH AVE SE APT 105
DEVILS LAKE ND
58301-3975
US

V. Phone/Fax

Practice location:
  • Phone: 701-331-1293
  • Fax:
Mailing address:
  • Phone: 701-331-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: