Provider Demographics
NPI:1790185668
Name:CHITTICK, STACY ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ELIZABETH
Last Name:CHITTICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:ELIZABETH
Other - Last Name:SCHLEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55182 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5361
Mailing Address - Country:US
Mailing Address - Phone:586-215-3159
Mailing Address - Fax:
Practice Address - Street 1:55182 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5361
Practice Address - Country:US
Practice Address - Phone:586-215-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243827363LA2100X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine