Provider Demographics
NPI:1700292489
Name:STINSON, BRITTNEY
Entity Type:Individual
Prefix:MISS
First Name:BRITTNEY
Middle Name:
Last Name:STINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CADILLAC SQ
Mailing Address - Street 2:14I
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2840
Mailing Address - Country:US
Mailing Address - Phone:248-250-3731
Mailing Address - Fax:
Practice Address - Street 1:35640 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48227
Practice Address - Country:US
Practice Address - Phone:734-673-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI39390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program