Individual
STACEY ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(586) 588-1489
Mailing address
52688 SABLE DR, MACOMB, MI 48042-3567
(586) 588-1489
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704286180
MI
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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