Provider Demographics
NPI:1134274699
Name:COLEMAN, STEPHANIE ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:SOSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5701 BOW POINTE DR STE 212
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5400
Mailing Address - Country:US
Mailing Address - Phone:248-384-8310
Mailing Address - Fax:248-384-8312
Practice Address - Street 1:5701 BOW POINTE DR STE 212
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5400
Practice Address - Country:US
Practice Address - Phone:248-384-8310
Practice Address - Fax:248-384-8312
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0000894A363A00000X
MI5601003469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP24690Medicare UPIN
MION24430Medicare ID - Type Unspecified