Provider Demographics
NPI:1558102723
Name:STEPHENS, MICHAL ROCHELLE
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:ROCHELLE
Last Name:STEPHENS
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 1:1544 CANFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4207
Mailing Address - Country:US
Mailing Address - Phone:937-259-8309
Mailing Address - Fax:
Practice Address - Street 1:1805 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-5400
Practice Address - Country:US
Practice Address - Phone:937-277-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty