Provider Demographics
NPI:1528558962
Name:BROWN, STEPHANIE ALEXANDRA (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALEXANDRA
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ALEXANDRA
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12741 S SAGINAW ST STE 402
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2460
Mailing Address - Country:US
Mailing Address - Phone:810-694-7412
Mailing Address - Fax:810-344-9215
Practice Address - Street 1:12741 S SAGINAW ST STE 402
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2460
Practice Address - Country:US
Practice Address - Phone:810-694-7412
Practice Address - Fax:810-344-9215
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily