Provider Demographics
NPI:1417501842
Name:STICKLER, MEGHAN RACHELLE (NP-BC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:RACHELLE
Last Name:STICKLER
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21663 FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5341
Mailing Address - Country:US
Mailing Address - Phone:248-894-8861
Mailing Address - Fax:
Practice Address - Street 1:9640 COMMERCE RD STE 104
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4167
Practice Address - Country:US
Practice Address - Phone:248-363-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF07191118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily