Provider Demographics
NPI:1053039768
Name:STEVENSON, MICHELLE (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 HUDSON BLVD E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2189
Mailing Address - Country:US
Mailing Address - Phone:212-733-2758
Mailing Address - Fax:212-573-7351
Practice Address - Street 1:66 HUDSON BLVD E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2189
Practice Address - Country:US
Practice Address - Phone:212-733-2758
Practice Address - Fax:212-573-7351
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349867-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily