Healthcare Provider Details

I. General information

NPI: 1114813417
Provider Name (Legal Business Name): MICHELE MARIA STEVANOVICH FNP-C, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 COLLEGE PKWY STE 112
CARSON CITY NV
89706-7954
US

IV. Provider business mailing address

1761 COLLEGE PKWY STE 112
CARSON CITY NV
89706-7954
US

V. Phone/Fax

Practice location:
  • Phone: 775-400-1144
  • Fax: 775-302-1100
Mailing address:
  • Phone: 775-400-1144
  • Fax: 775-302-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number890948
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number890948
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: