1457722290 NPI number — STEPHANIE MURRAY HOUSEY CAA

Table of content: STEPHANIE MURRAY HOUSEY CAA (NPI 1457722290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457722290 NPI number — STEPHANIE MURRAY HOUSEY CAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSEY
Provider First Name:
STEPHANIE
Provider Middle Name:
MURRAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CAA
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:
1457722290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2126 LENNON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE WOODS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-1658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-896-9186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 ARLINGTON AVE
Provider Second Line Business Practice Location Address:
MAILSTOP #1137
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43614-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-383-3556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2015

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: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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