Provider Demographics
NPI:1033113568
Name:STUNER, MARY MARGARET (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:STUNER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48804-0667
Mailing Address - Country:US
Mailing Address - Phone:989-268-1337
Mailing Address - Fax:989-268-5452
Practice Address - Street 1:11116 PINE GROVE ROAD, SUITE B
Practice Address - Street 2:
Practice Address - City:VESTABURG
Practice Address - State:MI
Practice Address - Zip Code:48891
Practice Address - Country:US
Practice Address - Phone:989-268-1337
Practice Address - Fax:989-268-5452
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4310629 TYPE 11Medicaid
MI4310629 TYPE 11Medicaid