Provider Demographics
NPI:1336321215
Name:STETZ, SANDRA MARION (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARION
Last Name:STETZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 CLINTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2227
Mailing Address - Country:US
Mailing Address - Phone:248-618-9368
Mailing Address - Fax:
Practice Address - Street 1:3483 CLINTONVILLE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2227
Practice Address - Country:US
Practice Address - Phone:248-618-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206474163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)