Provider Demographics
NPI:1134517857
Name:MIRELES, STEPHANIE KRISTINE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KRISTINE
Last Name:MIRELES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4323
Mailing Address - Country:US
Mailing Address - Phone:517-290-6425
Mailing Address - Fax:
Practice Address - Street 1:201 EAST GRAND RIVER
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-290-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7510038512470A2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician