MEDICARE: MRS. MICHELLE LASSITER-STEPHENS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN180512	GA
2	363LF0000X	Family Nurse Practitioner	833832	NV

General Provider Information

NPI Number	:	1063828739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE LASSITER-STEPHENS FNP-C

Provider Business Mailing Address
First Line	:	1542 VISIBLE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4512
Country	:	US
Telephone Number	:	404-789-5063
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 VISIBLE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4512
Country	:	US
Telephone Number	:	404-789-5063
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	12/30/2021

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