Provider Demographics
NPI:1295202208
Name:WRIGHT, STEPHANIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9143 BIRCH RUN RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-9747
Mailing Address - Country:US
Mailing Address - Phone:989-244-6441
Mailing Address - Fax:989-244-6443
Practice Address - Street 1:9143 BIRCH RUN RD STE 3
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-9747
Practice Address - Country:US
Practice Address - Phone:989-244-6441
Practice Address - Fax:989-244-6443
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily