Provider Demographics
NPI:1427219898
Name:DUNNING, STACY ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANNE
Last Name:DUNNING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:ANNE
Other - Last Name:SOLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE
Practice Address - Street 2:SUITE 5200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2562
Practice Address - Country:US
Practice Address - Phone:616-486-5933
Practice Address - Fax:616-486-6489
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704155509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101019594OtherSTATE LICENSE
MI0P59060003Medicare PIN