Provider Demographics
NPI:1548735483
Name:GIALDI, STEPHANIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GIALDI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11885 E 12 MILE RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3465
Mailing Address - Country:US
Mailing Address - Phone:586-751-0732
Mailing Address - Fax:
Practice Address - Street 1:8545 COMMON RD STE 200
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6775
Practice Address - Country:US
Practice Address - Phone:586-751-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704314584OtherBOARD OF NURSING