Provider Demographics
NPI:1477709707
Name:VOORHEIS, STACEY CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:CHRISTINE
Last Name:VOORHEIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:48910-5894
Mailing Address - Country:US
Mailing Address - Phone:517-272-9700
Mailing Address - Fax:517-272-9706
Practice Address - Street 1:4202 COLLINS RD
Practice Address - Street 2:SUITE 115
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5894
Practice Address - Country:US
Practice Address - Phone:517-908-3600
Practice Address - Fax:517-908-3601
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant