MEDICARE: MICAELA STREVAY NP

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	252470	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	252470	AZ

General Provider Information

NPI Number	:	1669120812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAELA STREVAY NP

Provider Business Mailing Address
First Line	:	21454 E FREEDOM DR
Second Line	:
City	:	RED ROCK
State	:	AZ
Zip	:	85145-6050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21454 E FREEDOM DR
Second Line	:
City	:	RED ROCK
State	:	AZ
Zip	:	85145-6050
Country	:	US
Telephone Number	:	207-740-3666
Fax Number	:

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

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	01/17/2025

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