MEDICARE: MICHELLE LYNN STEWART

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1720822737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN STEWART

Provider Business Mailing Address
First Line	:	5307 HAMMOND LN
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-3520
Country	:	US
Telephone Number	:	937-768-5674
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 SCOTT CIR
Second Line	:	HICKAM MDG
City	:	JBPHH
State	:	HI
Zip	:	96818
Country	:	US
Telephone Number	:	937-768-5674
Fax Number	:

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

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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