Provider Demographics
NPI:1063970440
Name:STEWART, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PROVIDENCE MINE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2946
Mailing Address - Country:US
Mailing Address - Phone:530-265-2100
Mailing Address - Fax:530-265-2181
Practice Address - Street 1:202 PROVIDENCE MINE RD STE 203
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2946
Practice Address - Country:US
Practice Address - Phone:530-265-2100
Practice Address - Fax:530-265-2181
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies