Provider Demographics
NPI:1235637315
Name:FAYLOR, STEFANIA A (CRNA)
Entity Type:Individual
Prefix:
First Name:STEFANIA
Middle Name:A
Last Name:FAYLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STEFANIA
Other - Middle Name:
Other - Last Name:FORLINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:30400 TELEGRAPH RD STE 405
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5817
Mailing Address - Country:US
Mailing Address - Phone:248-594-9501
Mailing Address - Fax:
Practice Address - Street 1:1000 HARRINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2920
Practice Address - Country:US
Practice Address - Phone:586-493-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297241367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered