Provider Demographics
NPI:1164228813
Name:PRICE, STEPHANIE JO (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:PRICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71015 KESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MI
Mailing Address - Zip Code:49130-9638
Mailing Address - Country:US
Mailing Address - Phone:574-333-4903
Mailing Address - Fax:
Practice Address - Street 1:71015 KESSINGTON RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MI
Practice Address - Zip Code:49130-9638
Practice Address - Country:US
Practice Address - Phone:574-333-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28218358A163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency