Provider Demographics
NPI:1801068341
Name:MARY M. STUNER, CFNP, P.C.
Entity type:Organization
Organization Name:MARY M. STUNER, CFNP, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:STUNER
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:989-268-1337
Mailing Address - Street 1:11116 N PINE GROVE RD STE B
Mailing Address - Street 2:
Mailing Address - City:VESTABURG
Mailing Address - State:MI
Mailing Address - Zip Code:48891-9516
Mailing Address - Country:US
Mailing Address - Phone:989-268-1337
Mailing Address - Fax:989-268-5452
Practice Address - Street 1:11116 PINE GROVE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:VESTABURG
Practice Address - State:MI
Practice Address - Zip Code:48891
Practice Address - Country:US
Practice Address - Phone:989-268-1337
Practice Address - Fax:989-268-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145370363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4310629Medicaid
S49055Medicare UPIN