Provider Demographics
NPI:1306819156
Name:BURROWS, STEPHANIE ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:BURROWS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1834
Mailing Address - Country:US
Mailing Address - Phone:616-523-1400
Mailing Address - Fax:616-523-1401
Practice Address - Street 1:479 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1834
Practice Address - Country:US
Practice Address - Phone:616-523-1400
Practice Address - Fax:616-523-1401
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288710363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ58496Medicare UPIN