1033113568 NPI number — MRS. MARY MARGARET STUNER CFNP

Table of content: MRS. MARY MARGARET STUNER CFNP (NPI 1033113568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033113568 NPI number — MRS. MARY MARGARET STUNER CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUNER
Provider First Name:
MARY
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033113568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48804-0667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-268-1337
Provider Business Mailing Address Fax Number:
989-268-5452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11116 PINE GROVE ROAD, SUITE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VESTABURG
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-268-1337
Provider Business Practice Location Address Fax Number:
989-268-5452
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704145370 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4310629 TYPE 11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com