Provider Demographics
NPI:1447751300
Name:SINGH, STEFANIE (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-BC
Mailing Address - Street 1:904 MASON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:904 MASON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2215
Practice Address - Country:US
Practice Address - Phone:313-586-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303945363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner