Basic Information
Provider Information
NPI: 1275949398
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STINTON
FirstName: JULIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
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Mailing Information
Address1: 5900 BYRON CENTER AVE SW
Address2: MEDICAL ADMINISTRATION
City: WYOMING
State: MI
PostalCode: 495199606
CountryCode: US
TelephoneNumber: 6162523243
FaxNumber: 6162520260
Practice Location
Address1: 8941 N RODGERS CT SE
Address2:  
City: CALEDONIA
State: MI
PostalCode: 493168013
CountryCode: US
TelephoneNumber: 6162525300
FaxNumber: 6162525390
Other Information
ProviderEnumerationDate: 07/09/2014
LastUpdateDate: 12/04/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704196632MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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