Individual
STEPHANIE BURRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21475 POTOMAC ST, SOUTHFIELD, MI 48076-5576
(313) 450-2225
Mailing address
21475 POTOMAC ST, SOUTHFIELD, MI 48076-5576
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247200000X
TECHNICIAN
—
Enumeration date
09/30/2015
Last updated
09/30/2015
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