Individual
MRS. STEPHANIE VIDEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
760 W FRANKLIN ST, JACKSON, MI 49201-2048
(517) 780-9260
Mailing address
760 W FRANKLIN ST, JACKSON, MI 49201-2048
(517) 780-9260
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704261894
MI
Other
Enumeration date
10/23/2013
Last updated
10/23/2013
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