MEDICARE: MICHELLE SANSEVERINO

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	390200000X	Student in an Organized Health Care Education/Training Program		TN

General Provider Information

NPI Number	:	1881213320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SANSEVERINO

Provider Business Mailing Address
First Line	:	149 TRAILS CIR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-2642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 LEBANON PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-2415
Country	:	US
Telephone Number	:	615-889-6300
Fax Number	:

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

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	04/14/2020

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Directions to “ MICHELLE SANSEVERINO ” Practice Location

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