Provider Demographics
NPI:1942398987
Name:BORING, STEPHANIE E (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:BORING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48829-8740
Mailing Address - Country:US
Mailing Address - Phone:989-427-5320
Mailing Address - Fax:989-427-8220
Practice Address - Street 1:1021 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-8740
Practice Address - Country:US
Practice Address - Phone:989-427-5320
Practice Address - Fax:989-427-8220
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0157311520OtherBCBSM
MIN89090003Medicare PIN
MI0G36398009Medicare PIN