Provider Demographics
NPI:1568415479
Name:LAMONT, STEPHANIE LYNN (PAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:LAMONT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:7314 IRA LN
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-9362
Mailing Address - Country:US
Mailing Address - Phone:989-450-3841
Mailing Address - Fax:810-765-8169
Practice Address - Street 1:401 S BALLENGER HWY
Practice Address - Street 2:ATT SURGICAL SERVICES
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3638
Practice Address - Country:US
Practice Address - Phone:810-342-1341
Practice Address - Fax:810-342-1335
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1058200OtherNCCPA CERTIFICATE NUMBER