| Doctor Name: | MRS. MICHELLE STEVENSON/TARANGO |
| NPI Number: | 1275904120 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CERTIFIED HAIR LOSS |
| License Number: | |
| Business Practice Address: | 22243 County Road 374 Gladewater, TX - 756479661 |
| Business Phone Number: | 9038453430 |
| Business Fax Number: | |
| Mailing Address: | 22243 County Road 374, GLADEWATER |
| State: | TX |
| Postal Code: | 75647 |
| Phone Number: | 9033301811 |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2015 |
| NPI Last Update Date: | 10/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1744P3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | Prosthetics Case Management |
| Taxonomy Definition: | |