Provider Demographics
NPI:1760187645
Name:MICHAEL, STACY DALE (RN)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:DALE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48767-9438
Mailing Address - Country:US
Mailing Address - Phone:198-977-9949
Mailing Address - Fax:
Practice Address - Street 1:7315 THOMAS RD
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48767-9438
Practice Address - Country:US
Practice Address - Phone:198-977-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse