Individual
STEPHANIE RECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(952) 442-9770
Mailing address
233 W 1ST ST, WACONIA, MN 55387-1302
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704206853
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104378204
—
MI
01
—
SR206853
BLUE CROSS OF MI
MI
Enumeration date
03/22/2006
Last updated
04/22/2015
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