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MRS. STACIE DAWN VANDERVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2850 S INDUSTRIAL HWY SPC 5758, ANN ARBOR, MI 48104-6796
(734) 477-7298
(734) 998-2369
Mailing address
2850 S INDUSTRIAL HWY SPC 5758, ANN ARBOR, MI 48104-6796

Taxonomy

Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
4704254099
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
46848699
MI
Enumeration date
09/30/2009
Last updated
09/30/2009
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