Provider Demographics
NPI:1265817068
Name:STALTER, MICHELL KAY
Entity Type:Individual
Prefix:
First Name:MICHELL
Middle Name:KAY
Last Name:STALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-6541
Mailing Address - Country:US
Mailing Address - Phone:810-336-7797
Mailing Address - Fax:
Practice Address - Street 1:2437 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6541
Practice Address - Country:US
Practice Address - Phone:810-336-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider