Provider Demographics
NPI:1639329063
Name:STEFFEN, MISTY SUZETTE (CNM, FNP, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:SUZETTE
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:CNM, FNP, PMHNP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:SUZETTE
Other - Last Name:HARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP, CNM, PMHNP
Mailing Address - Street 1:981 KATHERINE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1622
Mailing Address - Country:US
Mailing Address - Phone:831-295-9196
Mailing Address - Fax:
Practice Address - Street 1:2542 S BASCOM AVE STE 100
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-5541
Practice Address - Country:US
Practice Address - Phone:800-913-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507188163WX0002X
CA19470363LF0000X, 363LP0808X
CANMW1058367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife