Provider Demographics
NPI:1881355592
Name:OLIVER, STACY LYNN (FNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 STILES RD
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-9106
Mailing Address - Country:US
Mailing Address - Phone:810-627-3608
Mailing Address - Fax:
Practice Address - Street 1:2386 STILES RD
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416-9106
Practice Address - Country:US
Practice Address - Phone:810-627-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF10210347363LF0000X
MI4704293481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily