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STACEY RENAE COUCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
18591 W 10 MILE RD, SOUTHFIELD, MI 48075-2619
(248) 621-9443
(248) 621-9553
Mailing address
23938 FAIRVIEW CT, FARMINGTON HILLS, MI 48335-3117
(313) 743-2512

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704321587
MI
363LF0000X
Family Nurse Practitioner
Primary
4704321587
MI

Other

Enumeration date
10/14/2021
Last updated
01/09/2024
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