MEDICARE: MRS. STEPHANIE ARLENE MAYNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1386975084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE ARLENE MAYNE

Provider Business Mailing Address
First Line	:	1229 SYLVAN AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-3934
Country	:	US
Telephone Number	:	616-706-1040
Fax Number	:	616-248-8688

Provider Business Practice Location Address
First Line	:	1229 SYLVAN AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-3934
Country	:	US
Telephone Number	:	616-706-1040
Fax Number	:	616-248-8688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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