Provider Demographics
NPI:1760693865
Name:PROEFROCK, STACIA MARIE
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:MARIE
Last Name:PROEFROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1609
Mailing Address - Country:US
Mailing Address - Phone:734-834-5392
Mailing Address - Fax:734-665-1568
Practice Address - Street 1:1611 CHANDLER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1609
Practice Address - Country:US
Practice Address - Phone:734-834-5392
Practice Address - Fax:734-665-1568
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife