Provider Demographics
NPI:1932768744
Name:OSTRANDER, STEPHANIE L (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:OSTRANDER
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 1:6240 RASHELLE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3934
Mailing Address - Country:US
Mailing Address - Phone:810-733-6300
Mailing Address - Fax:810-733-6344
Practice Address - Street 1:6240 RASHELLE DR STE 2
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3934
Practice Address - Country:US
Practice Address - Phone:810-733-6300
Practice Address - Fax:810-733-6344
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294927NSA190EH363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437352994OtherINTERNAL MEDICINE
MI1437352994Medicaid