Provider Demographics
NPI:1114568953
Name:STEPHEN, LINU ANN (RN, BSN, MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LINU
Middle Name:ANN
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:RN, BSN, MSN, FNP-C
Other - Prefix:MS
Other - First Name:LINU
Other - Middle Name:
Other - Last Name:SHIBU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3179 WALDON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1339
Mailing Address - Country:US
Mailing Address - Phone:470-429-9145
Mailing Address - Fax:
Practice Address - Street 1:3179 WALDON RIDGE DR
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1339
Practice Address - Country:US
Practice Address - Phone:470-429-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704317713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily