Provider Demographics
NPI:1457687279
Name:NEWHOUSE, STEPHANIE BRICKLYN (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BRICKLYN
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E STE 160
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6124
Mailing Address - Country:US
Mailing Address - Phone:248-598-5080
Mailing Address - Fax:
Practice Address - Street 1:1701 SOUTH BLVD E STE 160
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6124
Practice Address - Country:US
Practice Address - Phone:248-598-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2014-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253147364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health