Individual
STACEY BROOKE CANTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
5150 COOLIDGE HWY, ROYAL OAK, MI 48073-1001
(248) 655-3227
(248) 655-3237
Mailing address
130 TOWN CENTER DR, 203, TROY, MI 48084-1744
(248) 655-3227
(248) 655-3237
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704279344
MI
363LF0000X
Family Nurse Practitioner
Primary
4704279344
MI
363LF0000X
Family Nurse Practitioner
COA.14865-NP
OH
Other
Enumeration date
09/13/2013
Last updated
03/19/2024
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