Provider Demographics
NPI:1902181282
Name:LAFEVER, STEPHANIE KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:LAFEVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-7820
Mailing Address - Country:US
Mailing Address - Phone:507-236-3207
Mailing Address - Fax:
Practice Address - Street 1:37799 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1153
Practice Address - Country:US
Practice Address - Phone:734-464-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006211363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical