Provider Demographics
NPI:1508901968
Name:REY, STEPHANIE ANN (RNC,WHCNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:REY
Suffix:
Gender:F
Credentials:RNC,WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49570 CRUSADER DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1734
Mailing Address - Country:US
Mailing Address - Phone:586-286-9624
Mailing Address - Fax:
Practice Address - Street 1:8180 26 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5129
Practice Address - Country:US
Practice Address - Phone:586-786-5900
Practice Address - Fax:586-992-9331
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212885363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health