Provider Demographics
NPI:1750755906
Name:BROWN-STEPHENSON, MICHELLE ELAINE (BSN RN, MS, MLS,CHES)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:BROWN-STEPHENSON
Suffix:
Gender:F
Credentials:BSN RN, MS, MLS,CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MARTI DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6981
Mailing Address - Country:US
Mailing Address - Phone:817-551-5940
Mailing Address - Fax:
Practice Address - Street 1:1601 MARTI DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6981
Practice Address - Country:US
Practice Address - Phone:817-551-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631965163W00000X, 163WC1600X, 163WD0400X, 163WN1003X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No174H00000XOther Service ProvidersHealth Educator