Provider Demographics
NPI:1407999824
Name:CLUTTEN, STEFANIE LEA (PA)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LEA
Last Name:CLUTTEN
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Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:3394 E JOLLY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8594
Mailing Address - Country:US
Mailing Address - Phone:517-272-9700
Mailing Address - Fax:517-272-9706
Practice Address - Street 1:2815 S PENNSYLVANIA AVE STE 204
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3496
Practice Address - Country:US
Practice Address - Phone:517-267-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2020-01-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer