Provider Demographics
NPI:1275904120
Name:STEVENSON/TARANGO, MICHELLE (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:STEVENSON/TARANGO
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22243 COUNTY ROAD 374
Mailing Address - Street 2:22247 COUNTY ROAD 374
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-9661
Mailing Address - Country:US
Mailing Address - Phone:903-330-1811
Mailing Address - Fax:
Practice Address - Street 1:22243 COUNTY ROAD 374
Practice Address - Street 2:22247 COUNTY ROAD 374
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-9661
Practice Address - Country:US
Practice Address - Phone:903-845-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management