Provider Demographics
NPI:1063820074
Name:PEOPLES, STEFANIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15301 TIREMAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1045
Mailing Address - Country:US
Mailing Address - Phone:313-633-1483
Mailing Address - Fax:313-633-1812
Practice Address - Street 1:15301 TIREMAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1045
Practice Address - Country:US
Practice Address - Phone:313-633-1483
Practice Address - Fax:313-633-1812
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner