Provider Demographics
NPI:1760223770
Name:MANCZAK, STONE (FNP-BC)
Entity type:Individual
Prefix:
First Name:STONE
Middle Name:
Last Name:MANCZAK
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1662
Mailing Address - Country:US
Mailing Address - Phone:313-826-0179
Mailing Address - Fax:313-826-1092
Practice Address - Street 1:3040 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1662
Practice Address - Country:US
Practice Address - Phone:313-826-0179
Practice Address - Fax:313-826-1092
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704370249NSA240D7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily