Provider Demographics
NPI:1841650157
Name:STEPHAN, MICHELLE ANN (ND)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANN
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:SANDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:65 PALATINE
Mailing Address - Street 2:# 210
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8896
Mailing Address - Country:US
Mailing Address - Phone:951-206-1378
Mailing Address - Fax:
Practice Address - Street 1:65 PALATINE
Practice Address - Street 2:# 210
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8896
Practice Address - Country:US
Practice Address - Phone:951-206-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist