Provider Demographics
NPI:1356944490
Name:SPITERY, STEPHANIE OLIVIA (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:OLIVIA
Last Name:SPITERY
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 1:8772 EATON RD
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-1508
Mailing Address - Country:US
Mailing Address - Phone:248-303-2264
Mailing Address - Fax:
Practice Address - Street 1:30488 MILFORD RD
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-8583
Practice Address - Country:US
Practice Address - Phone:248-437-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant