Provider Demographics
NPI:1003285024
Name:HEBBERD, STEPHANIE A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:HEBBERD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:PERUSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:120 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-0561
Mailing Address - Fax:810-648-3352
Practice Address - Street 1:251 E PECK RD
Practice Address - Street 2:
Practice Address - City:PECK
Practice Address - State:MI
Practice Address - Zip Code:48466-9589
Practice Address - Country:US
Practice Address - Phone:810-378-4900
Practice Address - Fax:810-378-4905
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare UPIN