Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 33945 | KY |
Y | 2080P0204X | Pediatric Emergency Doctor | 33945 | KY |
NPI | 1134283286 |
---|---|
Provider Name | Michelle D Stevenson |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200442300 | (05) | IN |
2215801 | (05) | OH |
64004849 | (05) | KY |
H99745 | (02) |