Individual
QUIANA LYNELL STEPHENS-MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN CPNP
Contact information
Practice address
12800 KELLY RD, DETROIT, MI 48224-1506
(313) 372-3319
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704245159
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704245159
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164553099
—
MI
01
—
5008721450
BC IND PIN
MI
Enumeration date
09/04/2012
Last updated
12/10/2025
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