Healthcare Provider Details

I. General information

NPI: 1376979922
Provider Name (Legal Business Name): MICHELLE LYNN STEVENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2013
Last Update Date: 09/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NW PARKWOOD BLVD
PULLMAN WA
99163-2857
US

IV. Provider business mailing address

106 NW PARKWOOD BLVD
PULLMAN WA
99163-2857
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-9152
  • Fax: 866-264-1825
Mailing address:
  • Phone: 509-332-9152
  • Fax: 866-264-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00144155
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: