MEDICARE: MICHELLE STEVENSON

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	246RP1900X	Phlebotomy Technician		CA

General Provider Information

NPI Number	:	1578141487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE STEVENSON

Provider Business Mailing Address
First Line	:	1606 KNOLLWOOD AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5042
Country	:	US
Telephone Number	:	408-666-3881
Fax Number	:

Provider Business Practice Location Address
First Line	:	5687 SILVER CREEK VALLEY RD # 10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-2426
Country	:	US
Telephone Number	:	408-217-0988
Fax Number	:

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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Directions to “ MICHELLE STEVENSON ” Practice Location

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