Provider Demographics
NPI:1063828739
Name:LASSITER-STEPHENS, MICHELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:LASSITER-STEPHENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LASSITER-STEPHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1542 VISIBLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4512
Mailing Address - Country:US
Mailing Address - Phone:404-789-5063
Mailing Address - Fax:
Practice Address - Street 1:1542 VISIBLE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4512
Practice Address - Country:US
Practice Address - Phone:404-789-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180512363LF0000X
NV833832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily